The Role of Performance Measure Difficulty on Clinical Performance

Michael E Debakey Va Medical Center, Houston TX

Investigators

Abstract

BACKGROUND - The Institute of Medicine has advocated using performance and outcome measures as a critical tool to improve the quality of care. VA leads the industry in performance measurement through its EPRP, a comprehensive performance measurement system with over 90 indicators across six domains of health care value including quality. VA's investment has significantly improved quality of care, with VA facilities outperforming both the public and private sector. Nevertheless, preliminary analyses from the PI's currently ongoing career development award indicate that, though most measures show improvement over time, there is significant variability across measures. Potential alternative explanations, such as organizational characteristics or "performing to the test" (i.e. health care facilities tend to concentrate their efforts exclusively on the areas in which they are being measured), are unsupported by these analyses. Research from industrial/organizational psychology suggests that two performance measure characteristics, accomplishment difficulty and documentation difficulty, could considerably bias the validity of a performance measure if not accounted for. In this pilot project we will adapt and develop measures of these characteristics, and test their impact on clinical performance over time. The proposed work could markedly impact the way we measure, monitor, and reward quality of care in the VA and will help to ensure that VA remains a leader in health care quality by more accurately capturing the intended processes and outcomes of care. OBJECTIVES -- The objectives of this pilot research are(1) adapt and develop measures of documentation and accomplishment difficulty of outpatient quality EPRP measures, and (2) to assess the impact of documentation and accomplishment difficulty on VAMC performance trends of these measures. METHODS -- This research is a mixed methods study combining a retrospective database review of selected EPRP with expert ratings of EPRP measure characteristics. Performance measure subject matter experts will convene in focus groups to (a) help develop a measure of accomplishment difficulty and (b) assign ratings of documentation and accomplishment difficulty to a selected set of EPRP measures. We will use these ratings as covariates in latent growth curve analyses of these EPRP measures (acquired via a data use agreement with the Office of Quality and Performance to determine the impact of these measure level characteristics on performance over time.