Quality measures can be powerful tools for leveraging performance improvement, but only if they are based on reliable evidence, feasible to implement, and attributable to the providers being measured. Quality measures should also capture clinically relevant outcomes and other aspects of care that matter to patients.
Since the introduction of value-based care, quality measures have multiplied, but far too frequently, they fall short of these standards. This deficiency undermines the value of quality measurement, and not just for kidney care. In 2018, the American College of Physicians (ACP) Performance Measurement Committee determined that only 37% of the national measures being used to evaluate ambulatory care were valid (1).
“We weren’t surprised,” said Mallika Mendu, MD, medical director for quality and safety at Brigham and Women's Hospital in Boston and assistant professor at Harvard Medical School. The “we” she refers to are the members of the ASN Quality Committee. As quality and safety experts, she said, they regularly address questions about the value of quality measures, including those raised by the ACP paper, which she praised for providing the committee a framework to address their concerns.
MacLean CH, Kerr EA, Qaseem A. Time out - charting a path for improving performance measurement. N Engl J Med 2018; 378:1757–1761.
Mendu ML, et al.. Measuring quality in kidney care: An evaluation of existing quality metrics and approach to facilitating care delivery improvements. J Am Soc Nephrol 2020; 31:602–614.
Centers for Medicare & Medicaid Services. MIPS Value Pathways (MVPs). https://qpp.cms.gov/mips/mips-value-pathways. Accessed March 17,2020.