Efforts to create quality measures that actually matter to patients are hindered by inconsistent definitions, a general lack of focus on patients' overall care, and too many cooks in the metric-making kitchen, researchers say.
While patients may be concerned about outcomes such as mortality rates, surgical complications or readmissions, there has been too little traction on developing standardized metrics to track that information, wrote experts from Boston in a commentary published Wednesday in the New England Journal of Medicine.
Progress has been slowed by a current approach that lets “a thousand flowers bloom,” wrote Michael Porter and Dr. Thomas Lee of the Harvard Business School and Dr. Stefan Larsson at the Boston Consulting Group. Multiple organizations can reinvent the wheel, tweak existing measures or simply create their own. “The time has come to change this trajectory,” they wrote.
The commentary adds to mounting concern in recent years about the array of measures used to evaluate healthcare quality. Health policy, quality and safety researchers, as well as organizations that represent hospitals have urged greater scrutiny of the metrics that rate, rank and financially penalize U.S. healthcare facilities.
Some predict the push for a national board that sets standards for quality measurement will gain traction over the coming year. Current protocols for evaluating metrics are not robust, Dr. Peter Pronovost, director of the Armstrong Institute for Patient Safety and Quality at Johns Hopkins Medicine has said.
In their NEJM commentary, Porter, Larsson and Lee pointed to the International Consortium for Health Outcomes Measurement (ICHOM) as one avenue to help achieve that goal. The Harvard-affiliated consortium launched in 2006, and aims to publish standard sets of metrics covering more than 50% of the global disease burden by 2017.
According to the ICHOM website, it has already released health-outcome measure sets for several conditions, such as coronary artery disease, lung cancer, lower back pain and Parkinson's disease.
While outcome measures look at how patients fare after receiving care, much of the current focus has been on process measures, which look at how well facilities follow certain evidence-based clinical guidelines. Process measurement has had a limited impact on value, the Harvard researchers said in the NEJM. “Patients … are interested in results,” they wrote.
The Joint Commission, which gives accreditation to hospitals and other U.S. healthcare facilities, announced in November that it planned to shelve its popular Top Performer program for one year, “due to the evolving national performance measure environment.”
The organization had previously been criticized for overreliance on process metrics. In a recent conversation with Modern Healthcare, the group's CEO, Dr. Mark Chassin, argued that both process and outcome measures are essential to effective quality improvement. But few outcome measures meet the criteria for accountability, he said.
Health quality leaders from various organizations have also called for performance-rating groups to coordinate their efforts and more closely examine their measurement methodologies.
