Stringent quality measures fail to measure care provided

Broadly defined clinical quality measures could fail to accurately capture the true volume and quality of care provided, according to research published in the September/October issue of the Journal of the American Board of Family Medicine.

Many measures are “designed for querying health insurance data claims,” wrote lead author Allison Casciato, a medical student at Oregon Health & Science University in Portland, along with her colleagues. “Claims data, however, do not include the uninsured and may miss care that is delivered but not submitted for billing to the insurance plan. In addition, although many of the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) measures specify strict timelines for receipt of preventive serves, there is a general lack of evidence for much of this specificity.”

To determine the volume and quality of care captured by more broadly defined measures, researchers conducted a retrospective cohort study using EHRs from a clinic with a five-year-old system. The study included all 1,544 of the clinic’s patients aged six to 15 years and researchers assessed care provided to them against 24 pediatric quality measures outlined by CHIPRA, as well as a set of measures with clinically relevant modifications. Some of the measures included evaluation of quality care according to well-child visits, receipt of immunizations and documentation of body mass index percentile.

Expanding the definition of measures improved the rates at which they were met. For instance, the clinic met a CHIPRA measure requiring at least six well-child visits within 15 months from birth 52.4 percent of the time, but would have met the measure 60.8 percent of the time if that deadline were extended to two years. Also, a measure of immunizations provided was met 65 percent of the time according to the way it’s written, but met 70 percent of the time when parental objections were taken into account.  

Based on the results, researchers determined that “expanding requirements beyond strict timeframes may yield a real-world view of care received compared with the results obtained when following CHIPRA specifications. Allowing such ‘wiggle room’ is especially important when measuring care provided to publicly insured populations because they sometimes have sporadic patterns of care utilization and often experience gaps in insurance coverage.”