Quality measurement is critical to achieving the Department of Health Care Services’ priorities of improving health, enhancing quality and reducing the cost of care. Thus, we are committed to ensuring that DHCS develops the policy, infrastructure and analytic capacity to collect and use performance data to improve health outcomes.
The recent report, “Ten Criteria for Meaningful and Usable Measures of Performance,” developed by the Pacific Business Group on Health, provides valuable recommendations for selecting appropriate quality measures. There are several issues to consider regarding measure development, even with the availability of helpful guidelines.
One issue is the need for vertical alignment.Â There are multiple efforts at the national, state, local and institutional levels to advance quality through performance measurement. To the extent we can achieve vertical alignment or consensus, we will be able to make more valid comparisons, save time and resources and speed the adoption of quality measurement.
Another issue is stakeholder engagement, including members and patients, as well as those in the health care delivery system. Because there are different needs and perspectives among the many stakeholders, it is essential that there be ongoing dialogue with the stakeholder community. It is this engagement that will help to achieve vertical alignment.
Finally, we must remember that quality measurement is not an end in itself, but is valuable only if it improves health and health outcomes. Kenneth Kizer and Susan Kirsh note in a recent commentary in the Journal of General Internal Medicine — “The Double Edged Sword of Performance Measurement” — that performance measurement is, in fact, a “double-edged sword,” and that unintended, adverse effects can be generated with the introduction of performance measurement. Therefore, it is important to focus on health, clinical outcomes and patient experience as performance measures are introduced and tracked.
To address the above issues, DHCS is actively tracking performance measurement activities at the state, national and local levels and will be directly engaging with stakeholders to ensure that quality measures that are adopted are relevant and useful. These quality measures will not be selected in isolation, but will be given context as part of a DHCS Quality Strategy that will be developed in consultation with the UC-Davis Institute for Population Health Improvement, directed by Dr. Kizer. A national caliber advisory group will be formed by Dr. Kizer to provide consultation on the Quality Strategy, in addition to extensive stakeholder engagement.
DHCS is excited to work with like-minded partners to advance performance measurement that improves health, enhances care and reduces medical costs for all Californians.