Evidence-based measures designed for diabetes care

For the first time, organizations representing the perspectives of physicians, health plans, hospitals, and other health care organizations have cooperated in the development of a common set of evidence-based measures for evaluating performance in health care. The document was prepared jointly by the American Medical Association (AMA), the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), and the National Committee for Quality Assurance (NCQA). Representatives of those groups say it establishes broadly applicable measures for the management of adult diabetes.

The three organizations began work to integrate performance measure development in 1998 under the guidance of the Performance Measurement Coordinating Council (PMCC). The council was discontinued last year, but the three sponsors agreed to continue their joint efforts to develop condition-specific measurement sets.

The release of Coordinated Performance Measurement for the Management of Adult Diabetes lays the groundwork for testing a single-source approach to measuring performance of care provided to diabetes patients in multiple settings. Development of the document was led by a diabetes expert panel composed of clinical leaders and advisors in diabetes care.

The AMA, JCAHO, and NCQA view their collaborative initiative as a model of the efficiency that is achievable in the health care system. Improved efficiency is one of the six major "aims for improvement" proposed for the American health care system in the recent Institute of Medicine report, Crossing the Quality Chasm: A New Health System for the 21st Century.

E. Ratcliffe Anderson Jr., MD, AMA executive vice president, says the consensus document underscores the continued commitment of the AMA, JCAHO, and NCQA to speak with a common voice on critical public policy issues related to quality and performance measurement. In a series of meetings held over the past several months, senior executives of the partnering organizations have agreed upon a streamlined collaborative process and have begun to set joint priorities for the next several years.

"By working from established clinical practice guidelines for diabetes care and by identifying the key data elements, this collaboration has produced a model for performance measurement that is firmly grounded in science and ready for implementation," Anderson says. "The diabetes measures are the first in what we expect to be a series of collaborative measurement sets on clinically important topics. We also see this model as an excellent example of the evidence-based approach advocated by the National Quality Forum."

The National Quality Forum was created in 1999 as the result of the recommendations of the President’s Advisory Commission on Consumer Protection and Quality in the Health Care Industry. A public-private partnership, the Forum seeks to develop and implement a national strategy for quality measurement and reporting in health care, Anderson says. The AMA-JCAHO-NCQA collaboration has positioned itself to be an important source of standardized, empirically validated performance measures for review and potential endorsement by the Forum, he explains

Margaret E. O’Kane, NCQA president, says the next phase in the completion of work on the diabetes measures is a demonstration project designed with the Maine Medical Assessment Foundation (MMAF). A not-for-profit health services research and quality improvement organization, MMAF will use the diabetes measures in Maine as the basis for testing the feasibility of "single data collection," the collection of data for use in both physician- and plan-level performance measurement from a single source, such as physician offices.

"By working together, we are not only making performance measurement more efficient, we are also bringing measurement down to the level of the system where doctors and patients can relate to it and take advantage of it," O’Kane says.

O’Kane says the partners’ commitment to collecting data once, where feasible, and using it to fill the multiple needs of the health care system holds the potential for reducing duplicative and expensive data collection activities. The single-source approach is meant to ensure that physicians, provider organizations, and managed care plans receive consistent messages about the important aspects of diabetes care and may, in turn, improve the quality of that care.

Success in efforts to standardize measurement also will enable the AMA, JCAHO, and NCQA to remain responsive to the various needs of the health care system. Physicians and many health care organizations, for example, rely on measures as an educational tool and to support quality improvement efforts, but managed care plans and a growing number of provider organizations also rely on measures for external accountability and comparative reporting.

In a statement released with the announcement of the task force, Dennis S. O’Leary, MD, president of JCAHO, says the collaborative initiatives have "great potential to moderate the costs and data collection burden associated with performance measurement. This approach should also make good sense to purchasers, consumers, and other users of performance data and information."

To further ensure consistency in measuring performance related to diabetes care, the Diabetes Expert Panel and staff conferred with participants in the Diabetes Quality Improvement Project (DQIP). DQIP was formed in 1997, under the sponsorship of the Health Care Financing Administration, as a coalition of the major stakeholders in diabetes care. Organizations represented in this coalition included:

  • American Diabetes Association;
  • Foundation for Accountability in Health Care;
  • NCQA;
  • American Academy of Family Practice;
  • American College of Physicians-American Society of Internal Medicine;
  • The Centers for Disease Control;
  • Veterans Health Administration.

Barbara Fleming, MD, clinical advisor to HCFA and member of the DQIP operations group, says the congruence among the measures developed by the Diabetes Expert Panel and DQIP "tremendously enhances the usefulness of the measures. Hopefully, we can continue to work together to achieve broader implementation of these evidence-based measures and ultimately achieve our shared goal of improvement in the quality of diabetes care."

The adult diabetes performance measurement set is the first in a series of consensus measurement sets to be jointly issued by the AMA, JCAHO, and NCQA. Consensus measures focusing on cardiovascular disease and pregnancy and neonatal care are expected to follow within the next two years.

A copy of the Coordinated Performance Measurement for the Management of Adult Diabetes can be obtained on-line at www.ama-assn.org/ama/pub/category/3798.html