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Putting Measurement to Work: Improving the Quality of Health Care Delivered to Adults

Mastering the Challenges


Carla Zema, Kerr White Visiting Scholar, Agency for Healthcare Research and Quality (AHRQ).

Ravi I. Singh, Director, Consumer Communications Program, Foundation for Accountability (FACCT).

Dr. Tina Kitchin, Medical Director, Oregon Office of Developmental Disability Services.

Mr.Singh and Ms. Zema examined the many challenges policymakers face in measuring performance, such as limited resources, small numbers, and lack of validated measures in some areas. The speakers identified several approaches that policymakers can use, singly or in combination, to address these challenges:

  • Use tools that have strong technical support. The Consumer Assessment of Health Plans (CAHPS®) Survey and Reporting Kit contains all CAHPS® survey instruments, analysis programs, reporting templates, and education and marketing tools. The Survey Users Network provides full technical assistance.
  • Leverage existing data collection efforts. Participating in national projects can gain policymakers comparative information and technical assistance. Participating in existing State-level efforts can also maximize resources. For example, including the FACCT adult screening tool in the CAHPS® survey enables policymakers to stratify all survey results by special needs status.
  • Measure commonalities across groups. Some aspects of quality care are common across all adults with chronic needs. Including all members of this group in a study will produce more reliable information than looking at subgroups individually.
  • Group measures to make the information more meaningful. FACCT's consumer information framework, for example, groups measures into:

    • The Basics.
    • Staying Healthy.
    • Getting Better.
    • Living with Illness.
    • Changing Needs.
  • Develop new measures that can be used to examine State-specific issues. Developing a valid measure, however, is a lengthy resource-intensive process and comparative data will also need to be developed. But at times it may be the only option. (AHRQ's Child Health Toolbox contains helpful information on how to develop child health measures, information that also applies to measures of adult health.

Dr. Kitchin has found that small amounts of data can also be useful. Oregon developed a database containing reports on a defined list of serious incidents that occur to people served by home and community based waivers. Oregon has used this database to identify counties, providers, and individuals in trouble and other trends that can be addressed by training.

For example, the database identified the "fatal four," four health conditions that were causing more problems than they should. Based on this information, the State developed training, a teaching tool, and monitoring protocols to reduce the problems. The State was also able to determine that one person (who is now facing criminal charges) was at the bottom of multiple reports of financial exploitation.

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