Building a Better Quality Measure

BACKGROUND: National performance measures monitor the proportion of diabetic patients with low-density lipoprotein (LDL) levels >/=130 mg/dL, but such simple intermediate outcomes measure poor control, not necessarily poor care. "Tightly linked" quality measures define good quality either by a good intermediate outcome (LDL /=130 mg/dL using the simple intermediate outcome measure, only 13% (148 of 1154) were classified as having substandard quality using the tightly linked measure. Among the 159 reclassified to adequate quality, 117 had lipid-lowering medication started or increased within 6 months of an LDL >/=130 mg/dL, 8 were already on high-dose medication, 12 had a repeat LDL <130 mg/dL, and 22 had contraindications to treatment. CONCLUSION: Simple intermediate outcome measures can be an inaccurate reflection of true quality of care, and many patients classified as having substandard quality by "poor control" might actually be receiving good quality of care

Diabetes mellitus · Hyperlipidemia · Quality (philosophy) · Retrospective cohort study · Diabetes, Cardiovascular Risks, and Lipoproteins · Emergency Medicine · Endocrinology · Internal Medicine · Medication Adherence and Compliance · Medicine · Primary Care and Health Outcomes

• A retrospective cohort study of a community-based primary care program’s effects on pharmacotherapy quality in low-income Peruvians with type 2 diabetes and hypertension

  Open Access•John E Deaver, Gabriela M Uchuya et al.•PLOS Global Public Health•2024

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• Did Hedis Get it Right? Evaluating the Quality of a Quality Measure

  Gabriel Sanfélix-Gimeno, Gabriel Sanfélix‐Gimeno et al.•Medical Care•2014

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• Reasons for Not Prescribing Guideline-recommended Medications to Adults With Heart Failure

  Michael A Steinman, Liezel Dimaano et al.•Medical Care•2013

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• Impact of Comorbidity Type on Measures of Quality for Diabetes Care

  Lechauncy Woodard, LeChauncy D Woodard et al.•Medical Care•2011

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• Gender and Racial Disparities in the Management of Diabetes Mellitus Among Medicare Patients

  Open Access•Ann F Chou, Arleen F Brown et al.•Women s Health Issues•2007

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• Guideline Adherence of Veterans Health Administration Primary Care for Abnormal Uterine Bleeding

  Open Access•Kristina M Cordasco, Anita H Yuan et al.•Women s Health Issues•2019

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• Clinical Management Strategies and Diabetes Quality

  Eve A Kerr•Medical Care•2004

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• Treatment Intensification and Risk Factor Control

  Joseph V Selby, Connie S Uratsu et al.•Medical Care•2009

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• Implications of New Geriatric Diabetes Care Guidelines for the Assessment of Quality of Care in Older Patients

  Elbert S Huang, Greg A Sachs et al.•Medical Care•2006

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• Physician Process and Patient Outcome Measures for Diabetes Care

  Marcia M Ward, Jon W Yankey et al.•Medical Care•2004

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• Predicted Quality-Adjusted Life Years as a Composite Measure of the Clinical Value of Diabetes Risk Factor Control

  Julie Schmittdiel, Julie A Schmittdiel et al.•Medical Care•2007

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• Cross-Sectional Versus Sequential Quality Indicators of Risk Factor Management in Patients with Type 2 Diabetes

  Jaco Voorham, P Denig et al.•Medical Care•2008

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• Improving Hypertension Quality Measurement Using Electronic Health Records

  Stephen D Persell, Abel N Kho et al.•Medical Care•2009

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• Treatment of Depression in Primary Care

  Wayne J Katon, Wayne Katon et al.•Medical Care•2004

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• The Urgent Need to Improve Health Care Quality Institute of Medicine National Roundtable on Health Care Quality

  Mark R Chassin•JAMA•1998

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