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Few Outcome Measures Meet Criteria for Assessing Accuracy and Validity, According to Two Joint Commission Executives

New Article in the Annals of Internal Medicine Suggests National Critical Look is Needed

August 15, 2017
By: Katie Looze Bronk, Media Relations Specialist

(OAKBROOK TERRACE, Illinois – August 15, 2017) – Federal public reporting and payment programs increasingly emphasize the measurement of outcomes such as readmission, healthcare-associated infections and mortality rates. Outcome measures are intended to quantify the end results of a health care service or intervention. Yet, criteria for assessing whether they are accurate and valid enough to use for public reporting, payment and other accountability programs are not well defined. 

A new article in the Annals of Internal Medicine, “Holding Providers Accountable for Health Care Outcomes,” by David W. Baker, MD, MPH, FACP, executive vice president, Division of Health Care Quality Evaluation, The Joint Commission, and Mark R. Chassin, MD, FACP, MPP, MPH, president and CEO, The Joint Commission, suggests a national critical look is needed on how to assess the validity of outcome measures used by public accountability programs. In the article, Drs. Baker and Chassin offer four criteria:

  • Strong evidence should exist that good medical care leads to improvement in the outcome within the time period for the measure.
  • The outcome should be measurable with a high degree of precision. 
  • The risk-adjustment methodology should include and accurately measure the risk factors most strongly associated with the outcome.
  • Implementation of the outcome measure must have little chance of inducing unintended adverse consequences.  

The criteria were applied to 10 outcome measures currently used or proposed for accountability programs:

  • The Centers for Medicare & Medicaid Services’ (CMS) chronic obstructive pulmonary disease, heart failure, stroke and pneumonia measures
  • The Society of Thoracic Surgeons and New York State Cardiac Surgery Reporting System’s coronary artery bypass graft surgery measure
  • The National Surgical Quality Improvement Program’s (NSQIP) surgical site infection measure
  • The National Healthcare Safety Network’s (NHSN) central line-associated blood stream infection measure
  • The Agency for Healthcare Research and Quality’s (AHRQ) venous thromboembolism measure
  • A proposed international standard set of measures related to changes in physical function and pain after joint replacement
  • The Hospital Consumer Assessment of Healthcare Providers and Systems’ (HCAHPS) survey

Three measures met all four criteria; five, including all four claims-based 30-day mortality measures, failed to meet one or more criteria. 

“The Joint Commission supports the transparency and public reporting of reliable and valid data on quality and has made such information about accredited organizations public for more than 20 years,” Dr. Baker said. “However, the nation needs to take a more critical look at outcome measures. We found that most of the national measures did not pass all of the criteria, particularly the mortality measures.” 

“If we are going to publicly report outcomes and reward providers who achieve the best outcomes, we must approach outcome measures as rigorously as we did process measures and use extreme caution to ensure that the measures are valid.” 

 For more information about quality measures, please visit The Joint Commission website

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