The overall goal of the measure inventory was to provide a useful and usable inventory of measures that can be derived from APCDs. The inventory is based on a literature review and environmental scan completed in January 2015. It consists of measures identified in spring 2015 from the environmental scan, in consultation with a multi-stakeholder TEP, and with AHRQ program officer input. Collected measures related to cost, utilization, and quality focused on measures relevant to ambulatory care or measures across settings (inpatient and outpatient), because APCDs are distinguished from other widely available datasets (e.g., hospital discharge data) by the inclusion of claims across multiple settings. The measures also focused on high-priority conditions, chosen based on a brief environmental scan (spring 2015) of priority conditions identified by the Institute of Medicine, the National Quality Strategy, the Centers for Medicare & Medicaid Services, Healthy People 2020, and others (noted in Appendix B).
The high-priority areas included:
- Measures that are not condition specific, such as imaging and medication management.
- Measures that address specific high-priority conditions, (i.e., cardiac disease, preventive services, kidney or bladder conditions, mental health and substance abuse diagnoses, diabetes, and gastrointestinal disorders).
Several use cases for APCD-based measures have been proposed, including:
- Choice, defined as measures that inform consumer or purchaser decisions.
- Negotiation, such as use of measures in price or contract negotiation.
- Accountability, or measuring provider or plan quality and efficiency of care.
- Population health and policy, to assess population health and inform and assist in policy decisions for States (e.g., efforts to assess health reform efforts or decrease cost).
In the literature review, environmental scan, and discussions with the TEP, the team assessed the use case that might best support the development and use of APCDs and be most useful to the States sponsoring them. The TEP found that the State-based use case focused on population health management was likely the most immediately useful and feasible one.
The inventory includes 302 measures. Provided with each measure is a brief description of the measure, measure steward, NQF endorsement status, type of measure (cost, quality, or utilization), risk adjustment, and Web site or reference (if measure is from the literature) where the measure was found.
In addition, for a smaller subset of measures, the team conducted a "deep dive." The team chose deep dive measures from high-priority topics with measures for cost, quality, and utilization. These measures contain more detailed measure specifications, information on whether validity and reliability testing were conducted, and information on use in Federal programs, among other details.
In summary, a large number of measures are available for potential use with APCDs, covering a broad range of topics. Measures were grouped together to assess cost, quality, and utilization for specific topic areas for an assessment of population health management within or across diseases.
Although there are some limitations to both APCD data and the measures themselves, the measure inventory demonstrates that APCDs are potentially powerful new tools for monitoring population health. They can be used to paint a more complete picture of health care delivery, across payers and across settings, in ways that have not previously been possible. With continued development of both APCDs and measurement, stakeholders such as States, payers, providers, and consumers can look to use the APCDs to help fulfill the Triple Aim of better health, better quality, and lower costs.
