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Persistence of HMO performance measures.

ABSTRACT: To simplify the decision-making process, we propose and implement an approach to assess the stability of health plan performance over time when multiple indicators of performance exist.National Committee for Quality Assurance Health Care Effectiveness Data and Information Set data for childhood immunization for both publicly and non-publicly reporting health plans between 1998 and 2002. DATA/STUDY DESIGN: We use longitudinal data to examine whether plan quality ratings are stable from year to year. We estimate a parametric Multiple Indicator Multiple Cause Model, a model which allows us to aggregate the multiple measures of performance. The model controls for observed characteristics of the plan and market, allowing for unmeasured heterogeneity.We find moderate persistence in plan performance over time. A plan in the upper tier of performance in the year 1999 has only a 0.47 probability of remaining in the upper tier in the year 2001. Multiple years of good performance increase the probability of good performance in the future. For example, from the subset of plans in the upper tier of performance in 1999, 63 percent continued to perform in the upper tier in 2000. However, from the subset of plans in the upper tier in both 1998 and 1999, about three-fourths of the plans continued to perform in the upper tier in the year 2000. Finally, better performance in the more recent past is more indicative of better performance in the future than better performance in the more distant past.Although there is some persistence in health plan ratings over time, it is not uncommon for ratings of plans to change between when the data are generated and when actions based on that data, such as employers' contracting decisions or consumers' enrollment decisions, may take effect. Decision makers should be cognizant of this issue and methods should be developed to mitigate its consequences.

SUBMITTER: Swaminathan S

PROVIDER: S-EPMC2613996 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundThe Guidelines International Network (G-I-N) aims to promote high quality clinical guideline development and implementation. Guideline-based performance measures are a key implementation tool and are widely used internationally for quality improvement, quality assurance, and pay for performance in health care. There is, however, no international consensus on best methods for guideline-based performance measures. In order to address this issue, the G-I-N Performance Measures Working Group aimed to develop a set of consensus-based reporting standards for guideline-based performance measure development and re-evaluation.MethodsMethodology publications on guideline-based performance measures were identified from a systematic literature review and analyzed. Core criteria for the development and evaluation process of guideline-based performance measures were determined and refined into draft standards with an associated rationale and description of the evidence base. In a two-round Delphi-process, the group members appraised and approved the draft standards. After the first round, the group met to discuss comments and revised the drafts accordingly.ResultsTwenty-one methodology publications were reviewed. The group reached strong consensus on nine reporting standards concerning: (1) selection of clinical guidelines, (2) extraction of clinical guideline recommendations, (3) description of the measure development process, (4) measure appraisal, (5) measure specification, (6) description of the intended use of the measure, (7) measure testing/validating, (8) measure review/re-evaluation, and (9) composition of the measure development panel.ConclusionsThese proposed international reporting standards address core components of guideline-based performance measure development and re-evaluation. They are intended to contribute to international reporting harmonization and improvement of methods for performance measures. Further research is required regarding validity, acceptability, and practicality.

Project description:BackgroundLowering hospital readmission rates has become a primary target for the Centers for Medicare & Medicaid Services, but studies of the relationship between adherence to the recommended hospital care processes and readmission rates have provided inconsistent and inconclusive results.ObjectiveTo examine the association between hospital performance on Medicare's Hospital Compare process quality measures and 30-day readmission rates for patients with acute myocardial infarction (AMI), heart failure and pneumonia, and for those undergoing major surgery.Design, setting and participantsWe assessed hospital performance on process measures using the 2007 Hospital Inpatient Quality Reporting Program. The process measures for each condition were aggregated in two separate measures: Overall Measure (OM) and Appropriate Care Measure (ACM) scores. Readmission rates were calculated using Medicare claims.Main outcome measureRisk-standardized 30-day all-cause readmission rate was calculated as the ratio of predicted to expected rate standardized by the overall mean readmission rate. We calculated predicted readmission rate using hierarchical generalized linear models and adjusting for patient-level factors.ResultsAmong patients aged ≥ 66 years, the median OM score ranged from 79.4 % for abdominal surgery to 95.7 % for AMI, and the median ACM scores ranged from 45.8 % for abdominal surgery to 87.9 % for AMI. We observed a statistically significant, but weak, correlation between performance scores and readmission rates for pneumonia (correlation coefficient R = 0.07), AMI (R = 0.10), and orthopedic surgery (R = 0.06). The difference in the mean readmission rate between hospitals in the 1st and 4th quartiles of process measure performance was statistically significant only for AMI (0.25 percentage points) and pneumonia (0.31 percentage points). Performance on process measures explained less than 1 % of hospital-level variation in readmission rates.ConclusionsHospitals with greater adherence to recommended care processes did not achieve meaningfully better 30-day hospital readmission rates compared to those with lower levels of performance.

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Persistence of HMO performance measures.

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