Improving the Quality of Quality Measurement

Development and Validation of Electronic Quality Measures to Assess Care for Patients With Transient Ischemic Attack and Minor Ischemic Stroke

“…For example, for some processes (eg, anticoagulation for atrial fibrillation), patient refusal can be a source of disagreement between the EHR and the medical record; in such a case, it may be possible to create elements in the EHR to identify patient preferences. 5 We determined in advance that the key consideration when evaluating eligibility would be the proportion of patients who were genuinely not eligible to receive a process and who were correctly identified as being not eligible on the basis of the EHR data (specificity) because implementation of quality metrics in practice requires avoiding the inclusion of patients who are not eligible for a given process. We also determined in advance that the proportion of patients who actually received the process and who were classified correctly by the EHR as passing the measure (sensitivity) would be the key consideration when evaluating passing validity because implementation of quality metrics in practice requires minimizing the classification of patients as fails when they actually received a process.…”

“…T here has been a call for using electronic health record (EHR) data instead of manual chart review to assess condition-specific quality of care for both processes of care and outcomes. [1][2][3][4][5][6] The Centers for Medicare and Medicaid Services (CMS) has proposed widespread adoption of electronic quality measures (eQMs) based on EHR data. 7 The articulated challenge for the next generation of clinical performance measures is to assess quality of care for an entire population longitudinally as opposed to conducting chart reviews on a sample of patients at single points in time.…”

Association Between Estimated Mortality Risk and Measured Quality of Care in Older Adults

“…25 Rather, we might need to introduce more-flexible measures that account for individual treatment goals, which should prevent the unintended consequences of overuse of care; 27 more measures of shared decision-making such as advance care planning measures in MIPS; 28 and clinical and selfreported outcome measures as some advocate, given the emerging evidence suggesting their value. 6,8,25,27 There are several limitations of this study. First, there is an assumption in this study that clinician predictions about prognosis are similar to that of the mortality index.…”

“…Although it is theoretically possible to add infinite numbers of exclusion criteria by using complex algorithms, doing so does not seem to be a viable option considering the current already significant measure burden . Rather, we might need to introduce more‐flexible measures that account for individual treatment goals, which should prevent the unintended consequences of overuse of care; more measures of shared decision‐making such as advance care planning measures in MIPS; and clinical and self‐reported outcome measures as some advocate, given the emerging evidence suggesting their value …”

The Challenges of Measuring, Improving, and Reporting Quality in Primary Care

“…CMS has just begun to evaluate patient-oriented outcome measures, and only for hip and knee replacement surgery. 52 For a practice that mostly performs such surgeries, this metric may allow policy makers to determine whether the practice is performing well. A 2-disease measure would be inappropriate and inadequate for primary care physicians.…”