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Workers' Compensation & Managed Care

Developing Performance Measures

Presenters:

Linda Rudolph, M.D., Medical Director, State of California Department of Industrial Relations, Division of Workers' Compensation Managed Care Program, San Francisco, CA.

Irma Arispe, Ph.D., Director of Evaluation Research, Department of Care Management and Outcomes Research, Johns Hopkins University—Bayview Medical Center, Baltimore, MD.


A crucial part of assessing the quality and effectiveness of any medical program is the development of accurate and appropriate performance measures. The purpose of this session was to examine the conceptual as well as the methodological issues related to developing performance measures specifically applicable to workers' compensation managed care.

Dr. Linda Rudolph discussed the complex conceptual issues concerning the development of workers' compensation appropriate performance measures. The specific areas where Dr. Rudolph feels that performance measures are needed are:

  • Access to care (in terms of time and provider appropriateness).
  • Clinical care.
  • Disability prevention.
  • Outcomes.
  • Patient satisfaction.
  • Employer satisfaction, and cost.

However, she noted that a key challenge in developing these measures is that quality is difficult to define in workers' compensation, because the type of measurements used in group health do not always apply to the conditions and patterns of care required in workers' compensation medical care. In addition, difficulties with gathering consistent data can make a quality evaluation difficult.

Dr. Irma Arispe discussed the efforts underway to develop clinical performance measures in the general health care field and identified a series of key questions to ask when considering developing such measures for workers' compensation programs or other applications. These questions included:

  • How do you determine what you should be measuring?
  • What key measurement concepts should you keep in mind when developing or selecting measures (e.g.,reliability; validity; the nature of data sources; risk adjustment issues)?
  • Should you develop your own measures or adapt those developed by other organizations?
  • What approach should you take to analyze the data?

Dr. Arispe noted that few performance measures exist specifically designed for workers' compensation. However, she described how CONQUEST [Computerized Needs-Oriented Quality Measurement Evaluation System], a software tool developed with support from the Agency for Health Care Policy and Research (AHCPR), can help policymakers, program administrators, and researchers in identifying adaptable performance measures, in areas such as low back pain, functional status, depression, and asthma.

References

Rudolph L. A Call for Quality. Journal of Occupational and Environmental Medicine April 1996;38(4):343-4.

Palmer RH, et. al. CONQUEST 1.0: Computerized Needs-Oriented Quality Measurement Evaluation System. U.S. Department of Health and Human Services, Agency for Health Care Policy and Research. (AHCPR Publication Number 96-N009): 1996; Attachment D.


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