How Research Helps Us Measure the Quality of Health Care: An Example from Diabetes Care
In health care, one of the most common questions asked by doctors, researchers, policymakers, and even patients is, “What works?” The answer lies in measuring and quantifying the quality of the different types of health care services that patients receive. To do this, quality measures are developed, typically through evidence-based research that points to a specific treatment, procedure, or drug as the clinical standard of care for a disease or condition. This research (often in the form of clinical trials) underpins much of what is practiced in medicine, providing critical information that helps the field determine the most effective treatments and approaches to helping patients.
But how do the results from a research study help inform a finalized quality measure that can then be used by patients, payers, providers and health insurance plans?
This week, Families USA released a new infographic that outlines the path to developing a quality measure, using a common blood test for diabetes care as an example. While not all quality measures are developed through this process, these common steps provide a useful illustration of a complex pathway.
How quality measures are developed
Research. As this graphic demonstrates, quality measurement often begins with medical research that links a particular process, structure, or outcome with improved patient care. In our example, a test for hemoglobin (blood) A1c levels is found to be a reliable predictor of how well a patient’s diabetes is being managed by his or her treatment plan— an important metric for reducing the risk of serious complications.
Evidence-base and clinical practice guidelines. When this research is evaluated within the context of the larger evidence base, themes may begin to emerge as new research supports existing findings. These themes are often synthesized into formal recommendations for care called clinical practice guidelines. For example, in its Standards of Medical Care in Diabetes guideline, the American Diabetes Association recommends that providers “perform the A1c test at least two times a year in patients who are meeting treatment goals (and who have stable glycemic control).”
Standard of care and measure development. As a critical mass of high-quality evidence coalesces around a treatment or procedure— in this case, routine A1c testing for the management of diabetes— a standard of care, or “best practice,” emerges. It is at this point, that measure development may come into play. As the medical community comes to an agreement around the standard of care of a particular disease or illness (such as requiring doctors to perform routine A1c testing on diabetes patients), quality measurement becomes a tool to ensure that the medical care that patients receive meets that standard.
Finalized quality measure and endorsement. In this example, the National Committee for Quality Assurance would develop and test a measure related to A1c testing for diabetes care. The finalized quality measure will measure the extent to which A1c testing is routinely completed for diabetes patients. When a group such as the National Quality Forum gets measure endorsement, this adds an additional stamp of approval to the quality measure and conveys that it reflects a thorough, scientific, and evidence-based review.
Measuring quality and defining standards of care helps consumers choose the best hospitals and providers
In practice, quality measures can significantly improve health care for consumers. For instance, when providers publicly report the effectiveness of the A1c measure in controlling diabetes, diabetes patients can use this quality measure to gauge how well providers and hospitals stack up against a standard of care. And, where detailed information is available, this measure can give patients meaningful information to help them select providers that consistently deliver high-quality care.