2.  Research Objectives o Evaluate the state of diabetes quality measurement, utilization & impact o Determine key strengths, weaknesses, gaps o Develop strategies to enhance value and impact of diabetes measures  Research Team o Thomas Jefferson University School of Population Health David Nash, Principal InvestigatorKathryn Kash, Qualitative Interviewer Neil Goldfarb, Co-InvestigatorRich Toner, Research Coordinator Al Crawford, Measurement AnalystBrian Leas, Project Manager Bettina Berman, Measurement Analyst  Timeline: Spring 2008 – Summer 2009  Funding o National Changing Diabetes Program of Novo Nordisk

3.  Environmental scan of diabetes quality measures ◦ Measure developers: Accreditation agencies, payers, physician groups, QI organizations, state/local initiatives ◦ All types of measures: Process, outcome, safety, etc. ◦ Specifications: Definitions, inclusion/exclusion, time frame ◦ Scope: Broadly representative of key sectors, rather than fully comprehensive  Key informant interviews ◦ Measure developers, physicians, payers, employers, QI orgs ◦ Representation from all relevant stakeholder groups ◦ Interviewees expert in both technical development and practical utilization of quality measures ◦ Semi-structured, recorded

4.  Step 1: National Quality Measures Clearinghouse (NQMC) ◦ Keywords: “diabetes” and “diabetes mellitus” ◦ 98 measures identified  Step 2: Supplemental search ◦ Roster compiled of key organizations & known measure sets ◦ Reviewed websites, contacted organizations for information ◦ 48 additional measures identified  Step 3: Data abstracted into Excel spreadsheet

5.  Descriptive characteristics ◦ Brief description ◦ Clinical topic (e.g. HgbA1c mgmt, lipid profile, foot exam) ◦ Developer ◦ Release and revision dates ◦ Broader measurement set ◦ Website link ◦ NQMC identification #  Specifications ◦ Level of measurement (e.g. clinician, health plan) ◦ Source of data (e.g. administrative, medical record, pharmacy, lab, registry) ◦ Numerator / denominator ◦ Inclusion / exclusion ◦ Time frame

6.  Validity ◦ Supporting evidence ◦ Extent of measure testing ◦ Composition of development group ◦ Endorsement by NQF and others  Policy-relevant domains* ◦ AHRQ: Process, outcome, access, structure, use of services, patient experience, population health ◦ IOM: Effectiveness, efficiency, equity, patient-centeredness, safety, timeliness * Dimensions as of 2008

7. Measure development, selection, endorsement ◦ National Committee for Quality Assurance ◦ National Quality Forum ◦ American Medical Association ◦ Centers for Medicare and Medicaid Services ◦ Ambulatory Quality Alliance ◦ Pharmacy Quality Alliance ◦ American Board of Medical Specialties ◦ American Board of Internal Medicine ◦ American College of Physicians ◦ Wisconsin Collaborative for Healthcare Quality Measure utilization and value ◦ Blue Cross Blue Shield Association ◦ Centers for Disease Control and Prevention ◦ Institute for Healthcare Improvement ◦ America’s Health Insurance Plans ◦ American Academy of Family Physicians ◦ Nat’l Business Coalition on Health ◦ American Diabetes Association ◦ American Association of Clinical Endocrinologists ◦ American Association of Diabetes Educators

8.  Scope of Measurement o Nearly 150 measures in > 25 distinct clinical categories o Primarily process measures o Substantial redundancy o Widely varying specifications o Evidence base often weak or unclear  Measurement Gaps o Primary prevention o Outcomes of care o Patient perspectives o Coordination of care o Access to care

9.  Highly useful for identifying relevant measures ◦ Although 1/3 of measures in our study had not been included in NQMC, many were later submitted by their respective authors ◦ Sufficiently specific and sensitive ◦ Capability to stratify by numerous categories ◦ Only known resource for identifying and comparing measure sets from different sources  Limitations ◦ Time lag from development to submission to posting ◦ Relies on self-reporting ◦ Until recently, limited data available on evidence base, validity, conflicts of interest

10. Brian Leas Research Analyst Center for Evidence-based Practice University of Pennsylvania Health System Brian.leas@uphs.upenn.edu