Assessing opportunities to advance quality measures in adult obesity.

OBJECTIVES: To evaluate the methodological soundness and performance of 3 obesity quality measures aimed at promoting improvements in obesity care. STUDY DESIGN: Retrospective, clinical, and administrative data-based observational research study to evaluate scientific soundness, feasibility, and performance of obesity quality measures. METHODS: Four test sites (clinicians/clinician groups) submitted clinical and administrative health data including patient demographics, diagnoses, and encounter information for patient panels encompassing individuals aged 18 to 79 years with at least 1 ambulatory visit between July 1, 2017, and June 30, 2018 (measurement period). Clinician/clinician group data were supplemented by an Optum data set contributing patient information from 21 health care organizations with approximately 6 million qualifying patients to assess the impact of using a larger data set for measure testing. Patients were excluded if they met any of the following criteria: were pregnant during the measurement period or in the 6 months prior to the measurement period, had died during the measurement year, or had evidence of palliative or hospice care during the measurement period. RESULTS: This study resulted in the identification of a clinician/clinician group-level measure, Documentation of Obesity Diagnosis, as being feasible and reliable; however, the measure requires additional evaluation and potential adjustments to determine validity. Other measures included in our evaluation had feasibility and methodological challenges due to data capture and coding limitations. CONCLUSIONS: Findings of our current study suggest that there are emerging opportunities to capture data and advance obesity measurement incrementally. A process measure focused on obesity diagnosis has the most potential for immediate implementation by clinicians, and additional measures focused on change in body mass index over time and use of evidence-based obesity treatment remain challenging to implement due to data capture and benefit coverage.

Improving quality measure maintenance: navigating the complexities of evolving evidence.

To be effective, healthcare quality measures must communicate clear, evidence-based standards to promote improved quality of care and outcomes. When the evidentiary foundation for measures changes, revisions must be made quickly and communicated clearly; otherwise, measures can confuse providers who are trying to reconcile the evidence-based care they deliver with outdated measure specifications. Outdated measures can also affect clinical decision making, potentially harming patients if the measures promote care that is not the best treatment for their condition according to the most recent evidence. This case study focuses on 2 measures for which the evidence base changed, yet implementation of revised specifications lagged and subsequently affected the payment programs in which the measures are used. The case study is shared to motivate collaboration among quality measurement stakeholders to advance shared responsibility for timely measure updates when evidence changes and to avoid confusion in measure implementation. Multiple parties share the responsibility for ensuring that measures are updated and aligned with evidence and practice recommendations. Issues of coordination among clinical experts, measure developers or stewards, and program implementers, including health plans, are not unique to any steward or implementer. The timing of new evidence releases and guidelines for the condition, service, or product being measured will always vary regardless of the measure update cycle for any one program. Changes to measure maintenance processes cannot totally negate these underlying challenges but can mitigate their impact. This case study calls for a national conversation to address opportunities for measure update process improvements.

Quality of child health care: expanding the scope and flexibility of measurement approaches.

Quality measurement can inform and encourage improvement in child health care. Currently, most measures gauge only whether care is received (e.g., receipt of a well-child care visit), providing little information about the actual content of care. We propose a measurement framework for comprehensive well-child care to capture a richer view of children's health care and take a more efficient approach to data collection. To promote measurement development, it will be necessary to: 1) align new measures with existing reporting requirements; 2) manage the burden of data collection; 3) weigh the evidence base; 4) consider adding new types of content; 5) develop clear but flexible measure specifications; and 6) consider children's enrollment patterns in Medicaid and the Children's Health Insurance Program. It also will be important to seek opportunities for eliciting families' views on the quality of well-child care.

Assessment and management of obesity and comorbid conditions.

To better understand obesity, its related conditions and risk factors, and the best assessment and management approaches for the adult population, the Disease Management Association of America and the National Committee for Quality Assurance partnered to conduct a literature review that could inform future initiatives of both organizations as well as others. The goals of the literature review were to: (1) describe the prevalence of obesity and related conditions and their health and financial impacts; (2) illustrate the clinical importance and interrelatedness of the conditions; and, the focus of this article, (3) describe the evidence supporting the different assessment and management options for obesity and comorbid conditions.

Measuring quality in arthritis care: methods for developing the Arthritis Foundation's quality indicator set.

OBJECTIVE: To develop a comprehensive set of explicit process measures to assess the quality of health care for osteoarthritis, rheumatoid arthritis, and analgesics use. METHODS: Potential quality measures and a summary of existing data to support or refute the relationship between the processes of care proposed in the indicators and relevant clinical outcomes were developed through a comprehensive literature review. The proposed measures and literature summary were presented to a multidisciplinary panel of experts in arthritis and pain. Using a modification of the RAND/UCLA Appropriateness Method, the panel rated each proposed measure for its validity as a measure of health care quality. RESULTS: Among 66 proposed indicators, the expert panel rated 51 as valid measures of health care including 14 for osteoarthritis, 27 for rheumatoid arthritis, and 10 for analgesics use. CONCLUSIONS: Sufficient scientific evidence and expert consensus exist to support a comprehensive set of measures to assess the quality of heath care for osteoarthritis, rheumatoid arthritis, and analgesics use. These measures can be used to gain an understanding of the quality of care for patients with arthritis.