Expert Meeting: April 15, 2010
Developing Quality of Care Measures for People with Disabilities: Summary of Expert Meeting
As noted by Dr. Clancy, the purpose of the meeting was to develop an action plan for creating quality of care measures for persons with disabilities, which could be derived from existing data. Although these quality metrics could eventually be used to identify disparities in care, identifying disparities was not the meeting's purpose. The focus was explicitly methodological (i.e., measure development) with the goal of developing a research agenda for AHRQ concerning health care quality metrics for persons with disabilities. Given the structure and brevity of the meeting, however, its goal was not to reach an explicit consensus (e.g., ranked list of research priorities). Instead, the purpose was to allow wide-ranging discussions to identify issues and for the interdisciplinary participants to present their perspectives and priorities.
The April 2010 meeting was the second meeting that AHRQ has convened to discuss a health services research agenda for persons with disabilities. AHRQ also sponsored a meeting on April 9-10, 2001, "Status of Health Services Research Associated with Disability." Results from that meeting were published in The Milbank Quarterly (Vol. 80, No. 2, 2002), with articles addressing the following topics: meeting health care needs of persons with disabilities,8 health care delivery system issues,9 health services research (HSR) for children with disabilities,10 evidence in disability outcomes and effectiveness research,11 and using administrative data for HSR concerning disability.12 The 2010 participants reviewed these papers before the meeting and sometimes framed their comments around elements of the 2001 discussions.
Dr. Clancy described the selection of meeting participants in her opening comments as follows:
We have selected participants with complementary expertise to consider the issue from multiple perspectives. Special competencies of this panel include health policy, physical medicine and rehabilitation, occupational science and therapy, geriatrics, gerontology, quality of care measurement, methodological and programmatic expertise, and expertise in many priority populations.
AHRQ aimed to invite relatively few participants so that the interdisciplinary group could engage each other fully in constructive dialogue and sharing of views. Inevitably, therefore, certain disciplines were not represented at the meeting. Participants were chosen based on their acknowledged expertise in relevant scientific and clinical areas and health services research; among Federal staff, individuals were selected from a range of agencies and organizations participating in disability-related activities within the Department of Health and Human Services (HHS), the Department of Education, and the Social Security Administration.
Appendix 1 lists participants at the 1-day meeting, which occurred at AHRQ's conference facility in Rockville, MD. Appendix 2 presents the meeting agenda. Lisa I. Iezzoni, MD, MSc, moderated the meeting, and given the explicit goal of developing a research agenda, Dr. Iezzoni frequently asked participants to frame their comments as research questions that could be addressed by AHRQ and/or its grantees. This report summarizes the meeting; the acronym RQ denotes the research questions (written in italics) articulated by meeting participants in making their points.
To further focus the discussion, Dr. Iezzoni made one additional stipulation. For AHRQ's National Healthcare Disparities Reports (NHDRs) and other Federal initiatives, considerable efforts have already been made, including by AHRQ staff, to develop population-based quality measures using national (e.g., National Health Interview Survey [NHIS], Medical Expenditure Panel Survey [MEPS]), and State (e.g., Behavioral Risk Factor Surveillance System [BRFSS]) survey data. Disability definitions for these quality metrics are by necessity delimited by the questions contained in the surveys. Furthermore, none of these population-based surveys allow determination of quality performance at the level of individual health care providers (e.g., hospitals) or health plans.
To improve quality of care for persons with disabilities—which must be the ultimate goal—it will be important to generate quality information at the health care provider and plan levels. Only then will providers or plans have information about their shortfalls or data to track their improvements. Therefore, Dr. Iezzoni stipulated that the day's discussion would focus primarily on designing quality measures that could be applied to individual health care providers or health plans, rather than population-based metrics derived from national or state surveys.