Choosing Quality Measures
Contents
Some Planning Suggestions
Factors to Consider
Reviewing Some Selected Measures
Choosing the most useful quality measures is one critical step toward success, no matter what your planned uses.
This section:
- Shares some planning suggestions from seasoned users.
- Identifies several factors State users may wish to consider when choosing quality measures.
- Reviews selected measures in terms of those factors.
Online Resource: For more information on uses of quality measures, go to: http://www.ahrq.gov/chtoolbx/uses.htm
Return to Contents 
Some Planning Suggestions
Circumstances differ across States and regions and over time. Despite such variation, the suggestions in this section have been made by experienced users in a variety of settings and may be useful to consider when developing quality measurement strategies.
Return to Contents
Think Long Term
Most uses of quality measurement are multiyear by nature. Discussing quality measurement as a multiyear venture from the beginning helps define realistic expectations and resource requirements.
Collecting quality measurement data for the first time is always a challenge. Therefore, consider designating the first year as a pilot year for which results are not published. This helps avoid publication of results that are more reflective of initial data collection problems than of quality. Publishing first-year results of uncertain quality may well undermine long-term plans.
Return to Contents
Consider All Available Measurement Tools
You may want to adopt an entire measurement set. Conversely, you may want to pick and choose among one or a number of measurement sets. Measures in different sets assess differing aspects of child health. Use of selected measures from different sets may provide the more complete or varied assessment you seek.
Return to Contents
Think Fewer Measures
Consider using fewer rather than more measures in your first years. This can lay the groundwork for later expansion of the number of measures collected, by demonstrating the feasibility and usefulness of quality measurement activities without overly taxing the resources of all parties involved.
Return to Contents
Develop a Plan
The collection, analysis, and use of quality measurement data are demanding, resource-intense activities for State staff as well as health plans and providers. Resources are always stretched. A clear focus on intended uses and information needs will help ensure that you collect only data that will be usable and useful.
Return to Contents
Factors to Consider
Many factors are involved in choosing which quality measures to use, whatever the intended purpose. Here are some key considerations:
Return to Contents
Making Comparisons
Do you plan to use quality measurement results to make comparisons? If so, what are you comparing? Credible comparisons of quality measurement results can be made only where specifications of data elements, data collection, and data analysis procedures are:
- Rigorous.
- Precise.
- The same for all results being compared.
If you want to make broad comparisons across numerous entities or geographic areas, the use of measures that have rigorous and precise specifications is more likely to yield results that can be credibly compared.
Return to Contents
Databases and Benchmarks
Do you want to be able to compare your results with an established database of comparable results? Do you want information on how your plan or program ranks with its counterparts? If so, you may want to use measures for which national databases and/or benchmarking information exist. Note that such information may exist only for selected measures in any given measurement set.
Return to Contents
Trends Over Time
Do you plan to use quality measurement results to track trends over time? If so, will you track the results of one entity or more? If only one entity is involved, almost any quality measure can be used, provided that a rigorous and highly precise set of specifications is developed and followed with each measure production cycle for:
- Data elements.
- Data collection.
- Data analysis.
If multiple entities are involved, the use of measures with rigorous and precise specifications is more likely to yield results that can be trended simultaneously and used credibly in trend line comparisons.
Return to Contents
Service Delivery Systems
Careful consideration of what service delivery systems you have will help steer you to the measures that will produce the best results for:
- Managed care.
- Primary care case management.
- Fee for service.
- All of the above.
Also consider whether you intend to compare results across or within service delivery systems.
Return to Contents
Unit of Analysis
Measures are often more suited to one type of unit of analysis than others. Consideration of the following questions will help you choose measures that will produce the best results. Do you plan to collect quality measurement data:
- On a statewide level?
- For managed care organizations?
- For a primary care case management program?
- For a fee-for-service program?
Return to Contents
Staff Experience an
d User Support
Assess the following:
- Does your staff have experience and expertise in quality measurement and data management?
- Is this area a new one for you and your staff?
- Do you anticipate needing extensive, explicit specifications concerning data elements, data collection, and analytical procedures?
Factors such as your own staff resource base or the availability of other local expertise may affect the value of and need for user support. Find out how much user support is offered with various measurement sets and the terms
under which it is available. Measurement sets vary in whether they:
- Are backed up by extensive user support resources.
- Include user groups, with varying forms of participation.
- Offer more or fewer types of resources.
- Are free of charge or entail costs.
Return to Contents
Costs
Regardless of the level of inhouse expertise, there are unavoidable costs associated with quality measurement. Here are some of the costs you will have to consider:
When assessing your costs, it is important to remember that quality measurement initiatives may reduce costs through identification of opportunities for cost-effective quality improvement.
Return to Contents
Reviewing Some Selected Measures
The information in Factors for Selecting Quality Measures can help determine whether to use one or more of the established quality measures discussed in Established Child Health Care Quality Measures in terms of these factors.
There are other measures that you may wish to consider for use in your program. Emerging Measures provides comments on some child health measurement development work now under way. Mental Health Quality Measures presents current initiatives in the development and use of mental health measures. Check the National Quality Measures Clearinghouse™, an AHRQ-sponsored compendium of quality measures suited for a variety of:
- Populations.
- Diseases.
- Conditions.
- Services.
The same factors can be used to assess any of these other measures.
Online Resources:
For more information on factors for selecting quality measures, go to: http://www.ahrq.gov/chtoolbx/cahptab.htm
For more information on established child health care quality measures, go to: http://www.ahrq.gov/chtoolbx/measures.htm
For more information on emerging measures, go to: http://www.ahrq.gov/chtoolbx/emerging.htm
For more information on mental health quality measures, go to: http://www.ahrq.gov/chtoolbx/measure9.htm
Return to Contents
Internet Citation:
Child Health Care Quality Toolbox: Choosing Quality Measures. July 2004. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/chtoolbx/choosing.htm
540 Gaither Road Rockville, MD 20850 