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Module 3: Quality & Efficiency Measurement

Multi-stakeholder Community Inventory Modules

Community quality collaboratives are community-based organizations of multiple stakeholders, including health care providers, purchasers (employers, employer coalitions, Medicaid and others), health plans, and consumer advocacy organizations, that are working together to transform health care at the local level. The Agency for Healthcare Research and Quality offers these organizations many tools to assist in their efforts.

Your Goals in This Inquiry

  • Identify resources and expertise in quality and efficiency measurement in your community. This includes quality and efficiency measurement at the delivery system level (e.g., clinic/practice location, medical/physician group, individual physician, hospital).
  • Delineate clinical quality measurement activities as well as patient experience of care activities. For example, a medical group in your community may be assessing quality of care for its patients with diabetes. This may involve gathering and analyzing clinical data on HbA1c levels as well as patient survey data on topics such as provider communication with patients, coordination of patient care, timeliness of care, etc.
  • Identify past measurement efforts.
  • Identify current measurement activities.
  • Identify current data aggregation efforts.
  • Understand how measures have been prioritized and selected (e.g., based on data availability or existing problems).
  • Identify goals of major stakeholders in developing and reporting quality and efficiency measures.
  • Identify contributors and users of measures from national campaigns/efforts, e.g., Leapfrog, CMS Compare, Joint Commission, CDC.

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Information You May Want to Gather

  • Existing local public reporting of any quality and efficiency measures.
  • Existing non-public reporting of any quality and efficiency measures, for example provider organizations' internal measurement.
  • Identify which measures are being used today and which are planned for the future.
  • Which measures purchasers are requesting or requiring.
  • Existence of collaborative efforts to aggregate data for measurement.

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Key Individuals to Contact

  • Measurement experts from providers including physician groups and hospitals.
  • Health plan measurement experts.
  • Quality improvement organizations (QIOs).
  • Purchasers who are requiring or requesting quality and efficiency measurement.

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Other Individuals to Consider Contacting

  • Individuals involved in measurement within public health agencies.
  • Academic researchers in health services, public health who have expertise in measurement.

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Suggested Questions

Communitywide Measurement Activities

  • Have there been any community wide measurement discussions or activities in this market and if so please describe?
  • Who has driven this activity — purchasers, health plans, providers, consumers, other?
  • Who else has been involved?
  • How was it decided what to measure, and how were the measures selected?
  • Are nationally recognized standard measures generally viewed as valid for this market?
  • What are the obstacles and challenges in advancing communitywide measurement?
  • What are enablers or supporters of measurement?
  • If applicable, how would you ensure that rural areas are included in measurement activities?
  • Are there geographic issues, such as distances, market service areas, local jurisdictions, or other boundaries, that may pose challenges to measurement?
  • Are there demographic issues such as age, income, or education levels that may pose special challenges?
  • Do you see any individual stakeholder as dominant in this market, for example, purchasers, providers, or health plans? If so, how might that impede or support the Community Quality Collaborative's measurement goals?

Stakeholder-Specific Measurement Activities

  • What specific initiatives have you or others in your stakeholder group undertaken related to quality and efficiency measurement? What are the lessons learned?
  • What are your current activities?
  • What are you measuring?
  • Is quality or efficiency the priority for your organization?
  • Are you using nationally recognized, NQF endorsed standard measures?
  • Is there a preference to use locally derived vs. nationally derived measures?
  • What challenges and obstacles have you faced in conducting measurement?
  • How have you used these measures, for example, for quality reporting, pay for performance, public reporting, in purchaser decisions, providing information to consumers, other?
  • What are your goals and plans for the future?
  • Who is involved? How should they be involved in the Community Quality Collaborative?

Future Community Quality Collaborative Measurement Activities

  • What should be the goals of the Community Quality Collaborative relative to measurement?
  • What would you like to see the Community Quality Collaborative measure?
  • Do you think the Community Quality Collaborative should prioritize quality or efficiency measures or both?
  • What could your organization contribute to the Community Quality Collaborative relevant to measurement? How do you envision being involved in the measurement activities of the Community Quality Collaborative?
  • Who else should be involved?

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Compiling Results

Tracking your activities and results of your inventory in a table similar to the one below will be useful for reporting activities to the Leadership Team.

Quality and Efficiency Measurement — Activities and Results
Interviewee NamePosition, OrganizationSummaryConclusions/Next Steps
After data have been gathered from all sources in the focus area, the Focus Area Team Leader and members may analyze the results by reviewing the goals identified at the beginning of this section and by identifying and summarizing the following aspects of the inventory findings with each other and with other Focus Area Team Leaders.
Quality & Efficiency Measurement — Analysis
Opportunities for Alignment 
Lessons Learned 

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Consensus Score Card

You may wish to develop a score for your Community Quality Collaborative's stage of development in each focus area to facilitate comparison of its stage of development across focus areas. You may discover differences in scores of individual key stakeholders for the same question. Identifying the degree of consensus among stakeholders will be useful in clarifying differing perceptions and goals and areas where consensus building may be useful for more effective collaboration.

If a quantitative approach doesn't fit in your situation, you may wish to use a more qualitative approach such as identifying areas of strengths and weaknesses or specific challenges and solutions.

  • Ask each team member to answer the following questions on a scale of 1-10 with 1 being the least developed and 10 being the most developed.
  • Average the scores of the team members, for each question, to get an average score per question.
  • Discuss any major differences between team members' scores to gain an understanding of each other's perspectives and knowledge.
  • Total the scores for all the questions and divide by the number of questions to get the score for this focus area.
  • Compare your Community Quality Collaborative's strength in this focus area to its strength in other focus areas in the overall Community Inventory Consensus Score Card when compiling and analyzing overall results from the tool.
Quality & Efficiency Measurement Consensus Score CardSCORE
1.  Our community has conducted measurement through a multi-stakeholder collaboration or cooperation. 
2.  These measurement initiatives have been successful. 
3.  Health care leaders in our community support measurement. 
4.  Measurement efforts have involved the Community Quality Collaborative stakeholders: purchasers, plans, providers, and consumers. 
5.  The Community Quality Collaborative is viewed as knowledgeable about measurement. 
6.  The Community Quality Collaborative includes the right individuals to accomplish its measurement goals. 
7.  The Community Quality Collaborative includes the right stakeholders to support community wide measurement initiatives. 
8.  The individuals at the table are willing and able to advocate on behalf of the Community Quality Collaborative measurement goals in their respective organizations. 
9.  Members of the Community Quality Collaborative will be able to reach consensus on priorities for measurement. 
10.  Members of the Community Quality Collaborative know others who are experts in measurement. 
11.  Health plans and provider organizations in this community are willing to share data. 
12.  Organizations involved in the Community Quality Collaborative are willing to share knowledge, expertise, and capabilities around measurement for the benefit of the community. 
13.  Organizations are willing to share resources, in-kind, financial or other, to achieve the Community Quality Collaborative's measurement goals. 
14.  There are sufficient resources to advance measurement in this market. 
15.  The individuals involved in measurement will devote adequate time and resources to the Community Quality Collaborative. 
16.  The Community Quality Collaborative will seek outside expertise if necessary to achieve its measurement goals. 
Total Score 

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Page last reviewed March 2009
Internet Citation: Module 3: Quality & Efficiency Measurement: Multi-stakeholder Community Inventory Modules. March 2009. Agency for Healthcare Research and Quality, Rockville, MD.


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