Q&A from the Measuring Up National Videoconference Held on September 22-24, 1998 on Quality Assurance Measures

Should we include indicators on social and community issues and not medical?

Yes, these issues are extremely important. The environment has a large influence on many aspects of care and should be addressed if possible.

How do we decide on priority health issues?

By having all the critical players at the table. You can use methods such as nominal group to rank and score the issues.

How do we control for extraneous factors that might effect the quality measures e.g. new legislation?

By keeping aware of these factors and developing ways to include that knowledge in your analysis and reporting of the measures.

How do we add an emerging issue to an already established set of quality assurance measures?

By developing a process that is flexible, and as emerging issues emerge, measures or targets should be changed accordingly.   

When establishing outcome measures, how do you set a limit on the number of items you measure?  How does that impact the ability to accurately measure data over time?

You limite them based on the resourcee you have to measure and analyze.  Because resources are so important kepp the number to an amount which you can maintain over time.

Is there a limit to the number of questions used for measures?

No, not in the development phase but you need to eventually settle on a number that you can actually address.

Structure, process and outcome appear to overlap, can you define these more clearly?

Think of structure as the inanimate object part of QA.  Examles include, written policies, interagency agreements, location, signage, etc.  Process is how the organization carries out the intent of some of the structural items.  Outcomes reflect the goals you have for the health of the individuals served AND they should relate to the structure and process measures.  If they do not, then it will be difficult to impact on the outcomes later if you cannot monitor structure and process.

How can we integrate multi-program data systems?

This can be a difficult task.  I suppose if you meet with the agencies you want to integrate with you would have to agree on target measures and then discuss how each of you currently collects data on those measures.

How do we establish goals when there are so many influences out of our control?

We need to maintain some sort of forward momentum even in a changing environment.   But because the environment is changing we need to set up a process which allows us to re-evaluate our goals on an annual basis and not be afraid to change them, if necessary.

Whose responsibility is it to gather, track, review and measure quality?

The contracted entity usually gathers/measures and reports the data.  The contracted entity may contract with an outside QA firm to review the accuracy of their data.  The agency providing the contract reviews the ability of the contracted agency to do all of the above.

Is financial support available for this type of quality assurance measurement?   Where?

It depends on the type of agency you are.  If you are an MCHB funded agency, quality measurement should be supported in part by MCH Block Grant dollars.  If you are a Medicaid agency then you build in the funding required into contracts.

QA methods - are we going to agree on standardized methodology?

There is some agreed on methodology in HEDIS.  Without a similar national initiiative I'm afraid that we will not.

What is the distinction between structure and process?

Structure includes physical issues such as "the presence of policies or procedures"  whereas process is how the policies are carried out.

What if we have no baseline data to establish a target value for a measure we developed?

How would you use/interpret measurement values when no baseline exists or no appropriate rate e.g. CSHCN?