BEST PRACTICES AND RESEARCH NEEDS IN QUALITY MEASUREMENT: FEEDBACK FROM QUALITATIVE INTERVIEWS WITH MEASUREMENT EXPERTS

Purpose: As part of an environmental scan of quality metrics, we conducted a series of interviews with local and national experts in quality measurement to understand current best practices in measurement, along with measurement gaps and needs for the future.

Methods: We conducted 12 semi-structured qualitative interviews with local and national stakeholders, by phone or in person. We identified potential interview participants via personal contacts and snowball sampling. Interview topics included: existing measures, measures in development, measurement gaps, and measurement priorities. The interviews were audio recorded.  The interviewers wrote up summaries of each interview which were discussed by the team to identify key themes. We described the findings of the interviews in an internal report and used the findings to develop a proposal to implement selected measures in primary care practices.

Results: Interview participants cited the utility of several known sources of measures, such as HEDIS and Meaningful Use. They discussed the importance of disease state measures while also addressing a broader perspective on measuring good quality care.  Common themes were: the need to start with a small set of measures before expanding; the importance of identifying measures that will work in your unique setting; incorporating composite measures; considering value; and identifying current measurement gaps, such as a global measure of overall quality, patient experience, patient activation, teamness among providers and staff, continuity of care, and transitions of care.

Conclusions: Successful quality measurement requires effort beyond selecting a few interesting measures. Providers and practices should approach this work systematically and must make thoughtful decisions about how best to incorporate measurement in their unique clinic. There is a need for ongoing measurement research, including measure selection, implementation strategies, and validation, as well as the need for research geared toward the development of new measures designed to provide meaningful information about the provision of care.