Outcomes/Effectiveness Research

Performance measures for gastroenterology can lead to improved accountability

In a trio of papers published over 3 months, Spencer D. Dorn, M.D., M.P.H., of the University of North Carolina School of Medicine, outlines the growing impact of accountability through performance measurement on gastroenterologists and the health care organizations in which they work. He notes that, culminating in the Patient Protection and Affordable Care Act, the medical profession is moving from a "golden age" in which physicians were completely trusted by their patients and had a great deal of autonomy in how they practiced medicine to an era of assessment and accountability. This occurs through how gastroenterologists are credentialed, how patients evaluate their care, and how the physicians are paid.

The three papers, supported by the Agency for Healthcare Research and Quality (HS19468), are described here.

Dorn, S.D. (2011, July). Gastroenterology in a new era of accountability: Part 1. An overview of performance measurement. Clinical Gastroenterology and Hepatology 9(7), pp. 563-566.

In this article, the author explains that gastroenterologists and other physicians are being held accountable for the quality and costs of care. He highlights the definition of quality of the Agency for Healthcare Research and Quality as "doing the right thing, at the right time, in the right way, for the right person—and having the best possible result." He explains the nature and differences between the four principal types of quality measures: structural measures (e.g., the use of electronic health records), process measures (e.g., immunization of patients with inflammatory bowel disease [IBD]), outcome measures (e.g., IBD-related hospitalizations or surgery), and patient experience measures (e.g., patient satisfaction with care). Cost of care and challenges in performance measurement conclude the article.

Dorn, S.D. (2011, August). Gastroenterology in a new era of accountability: Part 2. Developing and implementing performance measures. Clinical Gastroenterology and Hepatology 9(8), pp. 660-664.

In this paper, the author explains the lifecycle of performance measures, beginning with the setting of national priorities by organizations that represent multiple stakeholders, such as the National Quality Forum. Next is the development of performance measures by consortia or clinical specialty organizations such as the American Gastroenterology Association, followed by the evaluation and endorsement of the measures. Once endorsed, measures are prioritized for implementation and data is collected and eventually reported publically. Consumers can use reported performance data to make better decisions about care, and insurers can tie incentives to the level of performance. Further cycles of reporting allow hospitals and physicians to work to improve care.

Dorn, S.D. (2011, September). Gastroenterology in a new era of accountability: Part 3. Accountable Care Organizations. Clinical Gastroenterology and Hepatology 9(9), pp. 750-753.

This article discusses Accountable Care Organizations (ACOs) as an effort to control costs while improving quality of care and outcomes. The author defines ACOs as organizations that are designed to vertically integrate groups of health care providers to jointly assume responsibility for cost and quality of all care delivered to a defined population. If an ACO meets its quality and cost targets, it will be rewarded with a portion of the money it saved. The author then discusses how such organizations might form and operate under the Affordable Care Act, and how specialists fit into ACOs.

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