PATIENT-BASED QUALITY ASSESSMENT FOR CHRONIC DISEASE

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The measures of overall quality of care currently being developed and fielded in national quality initiatives such as NCQA, FACCT, JACHO and other organizations, are primarily designed for the general population being served by a health plan, or, if focused on specific diseases, rely on the medical record as the primary data source. Interest in surveys to capture information not contained in other sources, or to complement or substitute for more expensive and less reliable claims and medial records is increasing. Apart from expense, medical records are not adequate for assessing certain key indicators of plans performance such as patient satisfaction with health plan, quality of interpersonal care, or general or condition specific patient-perceived outcomes of care. We have developed a questionnaire containing comprehensive quality measures for patients with 3 common chronic diseases, asthma, diabetes and low back pain. This survey, designed to compare health plans, derives the majority of these general and condition-specific measures from those developed for AHCPR sponsored PORTs for the 3 index conditions. In a national field test of this questionnaire among over 12,000 patients in 39 health plans in 6 major geographically dispersed metropolitan areas, completed in August, 1997, preliminary analysis of those 4,000 patients with one of the three index conditions, suggests that these disease-specific measures of quality were more sensitive in discriminating between health plans than were general measures. We propose to conduct thorough testing of the sensitivity general vs. disease-specific quality measures in comparisons of health plans, and, using claims data, to validate many of these patient-based measures of disease-specific process and health outcomes. This proposal provides a rigorous field test of measures and methods developed in the diabetes, asthma and back PORTs, and examines the degree to which the patient report alone on in combination with claims data, can be used to create profiles that provide an accurate assessment of quality of care of health plans, leaving a relative small number of measures that must be collected from medical records. The product, at the end of two years, will be a valid, reliable and inexpensive to collect set of quality measures for 3 major chronic conditions, that can also serve as a model for other diseases.