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Mmmmm Making Meaningful Measures
Charles Gallia, PhD State of Oregon, Health Authority,
Division of Medical Assistance Programs
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How much do medical services contribute to health outcomes?
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An ‘Oregonized’ Care Model
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Tri-State Children's Health Improvement Consortium
CHIPRA Quality Demonstration Grant– A partnership between Alaska, Oregon,
and West Virginia Categories A, B, and C
– Test the full range of measures, expand the adoption of medical homes, and use of EMRs- an integrated model
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The Initial Core MeasuresFrequency of ongoing prenatal care Otitis Media with Effusion - avoidance of inappropriate use of systemic antimicrobials
Timeliness of prenatal careTotal EPSDT eligibles who received dental treatment services (EPSDT CMS Form 416 Line 12C)
% of live births weighing less than 2,500 grams Emergency Department Utilization - Average number of emergency room visits per member per reporting period
Cesarean Rate for Low-risk First Birth Women Pediatric catheter associated blood stream infection rates (ICU and high risk nursery patients)
Immunizations for 2 year-oldsAnnual number of asthma patients (> 1 year-old) with > 1 asthma related ER visit
Adolescent immunizationFollow-up care for children prescribed attention-deficit/hyperactivity disorder (ADHD) medication
Body Mass Index (BMI) documentation 2 - 18 year olds
Child and adolescent Major Depressive DisorderRates of screening using standardized screening tools for potential delays in social and emotional development
Follow up after hospitalization for mental illnessChlamydia screening 16-20 femalesAnnual hemoglobin A1C testing (all children and adolescents diagnosed with diabetes)
Well-child Visits 1) WCVs in the First 15 months of life; 2) WCVs in the third, fourth, fifth and sixth years of life; 3) Adolescent WCV
HEDIS CAHPS 4.0 including supplements for children with chronic conditions and Medicaid Plans
Total eligibles receiving preventive dental services Annual dental visitPharyngitis - appropriate testingAccess to primary care practitioners, by age and total
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As an Assuring Better Child Health and Development (ABCD) III State
Develop sustainable developmental screening and referral linkages
Using External Quality Review Process
Using Community Cafes Building on success
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Applying it
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Public Measures Refrain
When we report measures the reaction is familiar
• Like the grieving process• Critique : Not based on SMART
goals• Specific• Measurable• Attainable• Relevant• Timely
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Applying it
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Applying it continued
• The national average was 19.5%
• Based on current record enrollment, if Oregon was to be average- as a goal that equals 25,000 screenings (not taking in account real adjustment).
• Last year there was 12,000
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Does this measure have meaning? • To clinicians
• To parents
• To managed care organization
• To policy makers
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Harmonizing
Different Views Federal State Providers Consumers-
Citizens
Different Needs Value? Effective? Appropriat
e? Safe? Highest
quality
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Definitions
Measurement
Financing
Expertise
Shared Resources
TrainingRedesign
Quality Improvement
STATEPolicy
Framework
COMMUNITYCare
Coordination
PRIMARY CARE PRACTICE
Systematic Approach to Improving Health System Performance
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Measures vary
By the audience By method By message By meaning Macro and micro measures
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Solutions
• Understand – There are Macro and Micro health
care measures, of equal importance– Measures vary in value and meaning
• Engage stakeholders • Find areas of mutual achievement• Pool resources• Inspire Innovation
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Contact Information
Charles Gallia, PhD
State of Oregon
Division of Medical Assistance Programs
503-945-6929
