Many outcome measures, which are increasingly used as a basis for federal public reporting and payment programs, do not meet criteria assessing their accuracy and validity for use, an article, published in the Annals of Internal Medicine, shows.
Article authors, David W. Baker, MD, executive vice president, The Joint Commission's healthcare quality evaluation division, and Mark R. Chassin, MD, president and CEO of The Joint Commission, note that a critical look is necessary to assess the validity of outcome measures.
The authors suggest the following four criteria for validity assessment:
1. Strong evidence should exist that good medical care leads to improvement in the outcome within the time period for the measure.
2. The outcome should be measurable with a high degree of precision.
3. The risk-adjustment methodology should include and accurately measure the risk factors most strongly associated with the outcome.
4. Implementation of the outcome measure must have little chance of inducing unintended adverse consequences.
The authors applied the criteria to 10 common outcome measures and found that:
● Three measures met all four criteria
● Five, including all four claims-based 30-day mortality measures, did not meet one or more criteria
"If we are going to publicly report outcomes and reward providers who achieve the best outcomes, we must approach outcome measures as rigorously as we did process measures and use extreme caution to ensure that the measures are valid," said Dr. Baker.