Recorded presentation

Lok Wong, MHS, Quality Measurement, National Committee for Quality Assurance, 2000 L Street, NW, Suite 500, Washington D.C, DC 20036, 202 955 1784, wong@ncqa.org, Claudia M. Squire, MS, Research Triangle Institute, 3040 Cornwallis Rd., Research Triangle Park, NC 27709, and Philip Renner, MBA, Measures Development, National Committee for Quality Assurance (NCQA), 2000 L St., N.W., Suite 500, Washington, DC 20036.

Objective To develop valid survey questions to identify Medicare beneficiaries with urinary incontinence enrolled in Medicare+ Choice (M⁺C) plans, and to assess the quality of care received.

Design: Cognitive testing of survey questions with Medicare beneficiaries and validation of self-reported urinary incontinence (UI) against a validated instrument (Sandvik’s Severity Index). Respondents’ question comprehension, recall and decision processes were cognitively tested to identify respondents’ UI status, and whether a physician discussed and treated the patient’s UI. Cross-tabulations of responses against respondent characteristics were computed and correlation analyses conducted.

Population: In 2002, a total of 101 Medicare beneficiaries 65-85 years were recruited into the study from North Carolina, representing a diversity of education, race, age, sex, type of residence and UI profile.

Findings: Cognitive testing indicated most respondents understood the term “urinary incontinence” and examples of UI treatment. Responses to questions identifying respondents with UI using “a problem” scale were correlated with self-reported UI frequency and severity. The three-point “problem” scale (big problem, small problem, not a problem) captured more respondents who displayed UI symptoms than yes/no choices. Analyses indicated a higher correlation with the frequency and severity of UI using the “problem” scale than the binomial scale for respondents with stress incontinence (r=0.62, r=0.28) and urge incontinence (r=0.75, r=0.18). Education did not appear to be a significant covariate. Correlations with questions on the degree to which UI was a “bother” or affected patients’ daily activities were also high compared to the “problem” scale (r=0.87 to 0.89).

Conclusions: The study validated survey items to identify the denominator for a new HEDIS^® performance measure assessing how well health plans manage UI in M⁺C enrollees with UI 65 years and older. The clinical logic of the measure - assessing whether patients with a self-reported UI problem discussed UI with a physician and received treatment - is supported by the results. These questions may also be useful for clinical practice.

Implications: Rates of under-diagnosis and under-treatment for this debilitating condition are expected to improve with the implementation of the new HEDIS measure. Timely identification and appropriate management of urinary incontinence will improve the quality of life and functioning for seniors.

Learning Objectives:

• Describe methods for validating patient self-reported health status using survey items.
• Articulate the importance of accurate and valid identification of a population of interest for quality measurement and improvement purposes.
• Learning objectives - develop a quality of care indicator using survey items in a managed care or other clinical setting.

Keywords: Quality Improvement, Survey

Related Web page: www.ncqa.org

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: National Committee for Quality Assurance, HEDIS^® - Health Plan and Employer Data Information Set
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: National Committee for Quality Assurance - Employer

Recorded presentation