Group releases measures for diabetes care
Group releases measures for diabetes care
AMA, JCAHO, NCQA coordinate measurement
Three years ago, the American Medical Association (AMA) of Chicago, the Joint Commission on Accreditation of Health care Organizations (JCAHO) of Oakbrook Terrace, IL, and the National Committee for Quality Assurance (NCQA) in Washington, DC, announced they would start working to integrate performance measurements. Last month, the first set of evidence-based measures for evaluating performance in diabetes care was released.
Laying the groundwork
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. An expert panel of clinical leaders and advisors in diabetes care developed the document.
As it was a consensus document, its creation didn’t come without difficulty, says Andrew Chang, JD, MPH, JCAHO’s project director in the division of research and senior staff liaison to the AMA/JCAHO/NCQA collaboration. "Disagree-ment is not uncommon among measure developers," he says. But they worked through it, says Chang. "Perhaps more pertinent than the issue of disagreement is the question of how we elicited opinion from the Diabetes Clinical Expert Panel and, once obtained, how we combined the results to make decisions."
In the context of identifying performance measures for diabetes, the panel used group judgment techniques in order to make recommendations regarding appropriate measurement. For example, the American Diabetes Association and American Association of Clinical Endocrinologists have published guidelines on consensus care.
Settling disagreements about measures
When there were disagreements, "we generally defer to the established and most widely accepted standard of care," Chang explains. But when empirical data are incomplete or contradictory, and guidelines unclear, "expert opinion can provide a valued resource to aid in decision making. The diabetes consensus document is an excellent example of the evidence-based approach for measure development that is firmly grounded in science." he adds.
The expert panel also sought input from the Centers for Medicare and Medicaid Services’ (formerly the Health Care Financing Administration) 1997 Diabetes Quality Improvement Project participants. (See list of the measures the panel agreed upon, below.)
Recommended Measures for Patients with Diabetes | |
• | Frequency of HbA1c testing |
• | Control of HbA1c level |
• | Frequency of lipid testing |
• | Control of lipid levels |
• | Testing for microalbuminuria |
• | Frequency of screening examinations for diabetic retinopathy |
• | Frequency of foot examinations |
• | Influenza immunization status |
• | Frequency of blood pressure readings |
• | Control of blood pressure level |
• | Frequency of office visits |
Source: American Medical Association, Chicago. |
Demonstration project scheduled
The next phase in the diabetes measures program 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.
The goal is to collect data only once whenever possible, and use that single collection to fill multiple needs, hopefully reducing duplicate and expensive data collection activities.
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. Chang says it was chosen first because it had so much previous science and research behind it, and there was wide professional consensus on what good care entailed. Consensus measures focusing on cardiovascular disease, and pregnancy and neonatal care, asthma, and pain management 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 online at: www.ama-assn.org/ama/pub/category/3798.html.
[For more information, contact:
• Andrew Chang, JD, MPH, Project Director in the Division of Research, Joint Commission on Accreditation of Health Care Organizations, One Renaissance Blvd., Oakbrook Terrace, IL 60181. Telephone: (630) 792-5000.]
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