The National Quality Forum, which CMS uses as the source of most of its quality and other performance measures, asked the Rand organization to do an evaluation of the use of these performance measures. (Rand Report) The report relied on interviews and collection of publicly available materials from websites. The authors created four broad categories of measure use: quality improvement; public reporting; accreditation, certification, credentialing or licensure; and payment, including incentives and network tiering. The researchers distinguished between the primary end user of data, which is the organization collecting the data, and the secondary users, such as regulators, consumers or payers in some cases, who use the data for their own initiatives.
Public reporting and quality improvement were the most commonly reported end uses, although payment uses can be expected to increase with the implementation of various value-based purchasing initiatives. Seven core performance measure domains were identified: structure, process, outcome, access, safety, cost and patient experience. Different domains tend to be used for different end uses. Structural measures are used most often for accreditation, certification or licensing. Cost measures, interestingly, are used most often for public reporting and pay-for-performance. Patient experience measures are used most in public reporting programs. Access measures were the least used for any purpose. Hospitals use process of care, outcomes, safety and patient experience measures more frequently; whereas in the ambulatory setting process of care, outcomes, patient experience and cost have the highest measure domain use.
Obviously government programs are a significant driver of measure use. Availability of data was identified as the critical factor in being able to effectively use performance measures. Getting providers to accept and support use of performance measurement was also listed as very important. Some factors impeding measure use include “measure fatigue”, inconsistent measures across multiple initiatives and getting good data when there may be small sample sizes. Most organizations reported little systematic change as a result of performance measurement, including little impact on consumer behavior. In the future, the report suggests finding additional measures that address specialty care, but at the same time trying to find a way to coordinate measures and reduce the burden of collecting, analyzing and reporting data.