Is Our Approach to Quality Measurement Getting in the Way of Quality?

June 1, 2015 / By L. Gordon Moore, MD

The path to better population health outcomes is difficult–and our approach to quality measurement may be making it harder. Process measure improvement does not consistently lead to outcomes that matter, and narrow-focus outcome measures sometimes apply to a very small part of the overall population.

We as humans can attend to only so many things at a time. It is no wonder that systematic studies of improvement programs with long lists of measures find some improvement while others decline due to inattention.¹ Programs intended to help improve outcomes may instead be “costly and wasteful, and may succeed more in documentation of policies than in supporting improved outcomes in practices.”²

Good population health outcomes are supported on a foundation of high performing primary care.³ Through changes in measurement and payment we intend to support good primary care and good population health management, but if the net result is well-documented policies and improved processes with no substantive change in outcomes, our intent has been thwarted.

The Colorado Clinical Quality Measures Matrix is one of many examples of the measure overload afflicting our health care delivery system.

Figure 1 is one set of measures addressing diabetes:

Figure 2 shows the page of measures from which I extracted Figure 1:

Figure 3 shows six of the seven pages of the full Matrix:

Bottom line: Our approach to quality measurement is getting in the way of quality. Our strengths in data and analytics will be able to serve up a nearly endless buffet of metrics, but will it feed our need for real understanding? Will it lead to demonstrable improvement for populations?

Let’s use data and analytics to identify unexpected variation and opportunity for improvement, but let’s separate this work from how we understand and support quality. If the clinical delivery system succeeds in systematic improvement of access, relationships and comprehensive care and coordination—the essence of good primary care—population outcomes should soar.

L. Gordon Moore, MD, is senior medical director for populations and payment solutions at 3M Health Information Systems.

¹Gillam, S. J., A. N. Siriwardena, and N. Steel. “Pay-for-Performance in the United Kingdom: Impact of the Quality and Outcomes Framework–A Systematic Review.” The Annals of Family Medicine 10, no. 5 (September 10, 2012): 461–68. doi:10.1370/afm.1377.

²Ho, Lynn, and Jean Antonucci. “The Dissenter’s Viewpoint: There Has to Be a Better Way to Measure a Medical Home.” The Annals of Family Medicine 13, no. 3 (May 1, 2015): 269–72. doi:10.1370/afm.1783.

³Starfield, Barbara, Leiyu Shi, and James Macinko. “Contribution of Primary Care to Health Systems and Health.” The Milbank Quarterly 83, no. 3 (September 2005): 457–502. doi:10.1111/j.1468-0009.2005.00409.x.