Measuring Quality for People with Complex Needs: A New Approach
People with complex health status, particularly older adults with multiple chronic conditions, serious illness or frailty, often get health care that is fragmented, costly, potentially dangerous and, most importantly, care that may not reflect “What Matters” most to them.
Providing care that matters is a central tenet of Essential Attributes of a High-Quality System of Care for Adults with Complex Care Needs and an Age-Friendly Health System.
Existing quality measures do not capture what is most important to individuals, particularly older adults with functional limitations and complex health issues. Appropriate quality of care measures that capture What Matters to people are urgently needed to improve and incentivize care for the large and growing group of people with complex health status.
With support from The John A. Hartford Foundation and The SCAN Foundation, the National Committee for Quality Assurance (NCQA) joined forces with individuals and families, research experts and care organizations to develop person-centered outcome measures:
- Goal Identification
- Goal Follow-up
- Goal Progress or Achievement
“Person-centered outcomes” (or outcomes that matter to the person) are personalized, structured, measurable goals identified by a person with complex health status or caregiver and can be used for both care planning and quality measurement. NCQA identified two methods of measuring progress toward person-centered outcomes:
- Goal attainment scaling: Identify a goal and create a qualitative scale of possible quantifiable outcomes for that goal.
- Patient-reported outcome measures: select and use to measure a symptom or domain associated with a goal.
Building on Best Practices in Goal Setting
We’ve built this approach based on our research on best practices to goal setting with older adults and adults with physical disabilities and the work of national experts. We’ve found the best approach to goal setting includes having specific, measurable goals and a system in place to follow-up and revise goals as necessary.
Implementing Person-Centered Outcome Measures
Between 2016 and 2020, NCQA and thirteen organizations collaborated on testing the person-centered outcome approach. Findings from our research studies suggest that individuals, caregivers and providers found value in setting personalized measurable goals in care visits and that the person-centered outcome approach was feasible. These approaches improve the care planning process and provide valuable data on the range of goals that are important to adults and their caregivers.
Below two clinicians who participated in the implementation efforts tell stories about how person-centered outcomes impacted their patients.
- Refining a Taxonomy of Goals for Older Adults With Functional Limitations and Their Caregivers to Inform Care Planning
- Standardised approach to measuring goal-based outcomes among older disabled adults: results from a multisite pilot
- Patient and provider perspectives on using goal attainment scaling in care planning for older adults with complex needs
Promoting Health Equity
Everyone deserves fair and just access to high-quality health care that addresses their unique needs, reflects their diverse background and culture, and is designed to deliver the outcomes they want. The PCO measures drive care that matters to people and encourages organizations throughout the care continuum to work together in an integrated manner to help people achieve their health outcome goals. By organizing the healthcare system around what matters to people, their families and their community, we have the opportunity to deliver care that produces better health outcomes, in a more efficient, equitable and more cost-effective way.
During this project, we will develop messaging around the measures that resonates with and demonstrates value for diverse populations and viewpoints, recruit and engage organizations serving diverse populations for measure testing, and will include comparison of race, ethnicity, preferred language, and social needs in measure testing analyses to understand the impact of these measures.
To learn more about how the PCO measures promote health equity, please view our PCO and Health Equity overview or view our Health Innovation Summit presentation: NCQA 2022 Health Innovation Summit Session: Promoting Equity by Measuring What Matters Most – NCQA.
With funding from The John A. Hartford Foundation and The SCAN Foundation, NCQA is continuing this work through continued dissemination and implementation of the person-centered outcome measures to improve care.
This next phase of the work aims to
- Identify and prioritize pathways to facilitate the use of the measures in value-based payment programs.
- Implement an outreach campaign, with clear messages for health care plan and delivery system leadership as well as populations who experience significant health disparities and barriers in accessing quality care.
- Refine tools to support implementation and measure reporting that support clinician training and measure uptake, incorporate messages for diverse populations, and align measures that matter with care that matters.
NCQA will lead this work in collaboration with patient partners and a diverse multi-stakeholder advisory panel.
For information on how the PCO measures can impact your organization, please see our PCO Measures Overview.
Contact us by email at firstname.lastname@example.org.