TABLE 4-1Incorporating Advanced Measures Through Accountable Care Organizations

Basic Phase—Claims-Based Measures
ACOs have access to medical, pharmacy, and laboratory claims from payers
ACO ImpactQuality Improvement Measure
Care effectiveness/population healthCancer care acreenings
Diabetes care (LDL and A1c tests, eye exams, etc.)
Coronary artery disease care (LDL test)
SafetyHigh-risk medication for the elderly
Appropriate testing for patients using high-risk medications
Overuse/efficiencyImaging for low back pain (in absence of “red flags”) during first 30 days
Inappropriate antibiotic prescribing
Utilization rates of select services (e.g., C-section)
Intermediate Phase—Limited Clinical and Survey Measures
ACOs use specific clinical data (e.g., electronic laboratory results) and limited survey data
ACO ImpactQuality Improvement Measure
Care effectiveness/population healthImmunization rates for children and adolescents
Patients with diabetes whose blood sugar (A1c) are in control
Patients with diabetes or ischemic vascular disease whose lipids are in control
Patients with hypertension whose blood pressure is in control
Safety“Never events” in hospitals
Patient engagementPhysician instructions understood (Consumer Assessment of Health Providers and Systems [CAHPS])
Care received when needed (CAHPS)
Overuse/efficiencyEpisode-based resource use—linked to quality measures for common medical (e.g., diabetes, acute myocardial infarction [AMI]) and common surgical conditions (e.g., hip replacement)
Advanced Phase—Comprehensive Patient-Focused Measures
More complete clinical and robust patient-generated data
ACO ImpactQuality Improvement Measure
Care effectiveness/population healthComprehensive health risk summary score (body mass index, blood pressure, cholesterol, smoking, exercise, alcohol)
Stage-specific quality of life and functional outcomes for common cancers
Quality of life and functional outcomes for common conditions (e.g., AMI, hip replacement, diabetes)
SafetyHospital infection and risk-adjusted mortality rates Outpatient medication errors
Patient engagementCare plans—patient activation and engagement in chronic/ other conditions
Preference-sensitive conditions—level of information communicated regarding patient choice (e.g., knee surgery)
Patient preferences—adherence to design and execution of care plan (e.g., advanced directives)
Overuse/efficiencyEpisode-based resource use—linked to quality of life, functional and patient engagement measures for common medical (e.g., diabetes, AMI) and surgical conditions (e.g., hip replacement)

From: 4, Engaging Patient and Population Needs

Cover of Digital Infrastructure for the Learning Health System
Digital Infrastructure for the Learning Health System: The Foundation for Continuous Improvement in Health and Health Care: Workshop Series Summary.
Institute of Medicine (US); Grossmann C, Powers B, McGinnis JM, editors.
Washington (DC): National Academies Press (US); 2011.
Copyright © 2011, National Academy of Sciences.

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