Database offers one-stop shopping for measures

Tool lists conditions, performance indicators

A new software tool has been released by the government that will allow quality management professionals -- and others interested in performance measures -- to evaluate the myriad public and private measurement systems on the market without searching through volumes of research material. Best of all, the database software, called CONQUEST 1.0 and published by the Rockville, MD-based Agency for Health Care Policy and Research, is free.

CONQUEST 1.0 (Computerized Needs-Oriented Quality Measurement Evaluation System) acts as a searchable encyclopedia of guidelines and quality performance measurement systems, with information on about 1,200 clinical performance measures. Although it does not include the full text of the measures or the guidelines themselves, it does tell users where to obtain them.

Measures have been pretested

The database system allows users to select the most appropriate measures to assess the quality of health care services they provide. It also allows users to see which measures have been tested for validity and reliability.

"There is a lot of benefit in knowing which are the most valid and reliable measures of quality, so that [quality management departments] can just collect measures that are valid and reliable," says Patrice Spath, ART, a health care quality and resource management consultant based in Forest Grove, OR.

Often quality management departments use less-than-adequate measures because they are unaware of a better one, or they can spend a great deal of time searching for the most appropriate measures. CONQUEST 1.0 eliminates some of those frustrations, says R. Heather Palmer, MB, BCh (British equivalent of MD), SM, director of Center for Quality of Care Research and Education at the Harvard School of Public Health in Boston. Palmer and her colleagues at Harvard provided the methodological guidance for the development of CONQUEST 1.0.

"There are so many more measures than people are aware of, and this gives them an idea of what is out there," Palmer says.

CONQUEST 1.0 is actually two interlinked databases -- a condition database and a measure database. The condition database contains information on 52 clinical conditions, including those most prevalent in major health surveys and those found to be most costly to Medicare and Medicaid. The program summarizes recommendations from the Agency for Health Care Policy and Research's (AHCPR's) clinical practice guidelines and findings from AHCPR's Patient Outcomes Research Team projects.

Condition first, measure second

"The condition database tells you something about how common these conditions are and how serious the impact is on the population," Palmer says. "Then it tells you what services are recommended or not recommended by guidelines for those conditions. It tells you about potentially preventable adverse outcomes and risk factors and comorbidities. That sets people thinking about what is useful for us to measure. . . . If you use the condition database that way, you can cross over to the measure database."

The measure side of the CONQUEST 1.0 database contains 53 measure sets developed by a wide variety of government, business, research, and health care organizations, including the Health Care Financing Administration in Baltimore; the Joint Commission on Accreditation of Healthcare Organizations in Oakbrook Terrace, IL; the National Committee for Quality Assurance (NCQA) in Washington, DC; the American Group Practice Association in Alexandria, VA; and United Health Care in Minneapolis. For example, the Joint Commission's IMSystem and the NCQA's Health Plan Employer Data and Information Set (HEDIS) are included.

CONQUEST 1.0 gives information on each performance measure and gives the clinical rationale behind a given performance measure. Users can find methodological assumptions, data source requirements, sampling requirements, the clinical setting for which the measure was designed, and methods for "scoring" or analyzing a particular measure. Users can compare measures on how extensively they have been tested for reliability.

"You could say for this condition that I've now focused in on -- such as congestive heart failure -- I want to find measures related to it," Palmer says. For example, ACE inhibitor drugs are recommended for treating congestive heart failure (CHF), and the database would locate several valid measures related to the use of ACE inhibitors. Depending upon the situation, the user could determine the most accurate, most appropriate measure for his or her purpose. The same process can be used to locate measures on the use of potassium-sparing diuretics and tests for heart failure, among others.

2 databases in 1

Palmer explains the benefits of the two interconnected databases in CONQUEST 1.0. "If you search in the measure database for congestive heart failure, you will get measures directly related to congestive heart failure alone," Palmer says. "If you go from the condition database, you will get measures related to ACE inhibitors even if they were not originally developed for CHF. There may be other measures that relate to ACE inhibitors that were developed primarily for hypertension patients, but because they deal with monitoring for the dangerous side effects of ACE inhibitors, they might apply just as much to CHF patients. Those kinds of thought-provoking connections, you can only find by going through the condition database."

Palmer says the system was consciously set up that way to elicit creativity from performance measurers. "People don't understand what riches there are out there in terms of performance measures that other people have developed," she says.

A learning experience

The user's guide in CONQUEST 1.0 describes the features of the system and how it works. It also can be used as a tool for learning about performance measures. The guide explains how to evaluate and select measures for a given purpose, and how to identify and link performance measures that are clinically rated. The condition database gives information on common clinical conditions, their prevalence, and their impact on health costs and the health of populations, including comorbidities, risk factors, and potentially preventable conditions. With this knowledge in hand, the user can more ably search the measure database for performance indicators related to services and outcomes for a given condition.

For those not as familiar with quality measures and databases, CONQUEST 1.0 walks users through four measure retrieval scenarios, which demonstrate the software features and the interactivity between the condition and measure databases.

Volumes of info on disk

The system does have some drawbacks, Spath says. "It is important to note that the original work [for CONQUEST 1.0] looked at many performance measures, and the ones that they looked at are older and not the most current, cutting-edge ones," Spath says. That is significant because quality management professionals looking for information on newer outcomes measures that are being tested throughout the country will not find them in CONQUEST 1.0, she says. The program does not have quality of life or functional status types of outcomes. The measures are more process-oriented, such as number of patients receiving a mammogram out of the population of patients who should have received them.

In March 1995, the AHCPR published Understanding and Choosing Clinical Performance Measures for Quality Improvement: Development of a Typology. The two-volume set, the original work that set the foundation for CONQUEST 1.0, contains much of the information found in the program. All the information might not be new, but the format is. That is also significant, Spath says.

Program can be downloaded

"What [AHCPR] has done was to create a software version [of the two-volume manual on measures] that is more user-friendly," Spath says. "It is monumental that the U.S. government has created a software program like this. They create books and hard copy versions of things all the time, then someone has to take that book and translate it into a software program. Whereas now, it is already in a software program and is downloadable."

Those interested in giving CONQUEST 1.0 a test drive can download the program from a location in the AHCPR's web site, http//www.ahcpr. gov/research/CONQUEST.htm. A limited number of diskettes containing CONQUEST 1.0 may be obtained by calling the AHCPR's Publications Clearinghouse at (800) 358-9295 and asking for publication number 96N009. *