Online Program

Aligning quality agendas to drive system-wide transformation

Tuesday, November 5, 2013 : 2:50 p.m. - 3:10 p.m.

Iyah Romm, Massachusetts Health Policy Commission, Boston, MA
Kara Murray, MPH, Bureau of Health Care Safety and Quality, Massachusetts Department of Public Health, Boston, MA
Madeleine Biondolillo, MD, Director, Bureau of Health Care Safety & Quality, Massachusetts Department of Public Health, Boston, MA
Miriam Drapkin, MPH, Center for Health Information and Analysis, Boston, MA
Cristi Carman, MPH, Center for Health Information and Analysis, Boston, MA
Quality measurement is critical to evaluating healthcare delivery across settings, and to designing incentives that reward value. Proliferation of measures has furthered our ability to quantify healthcare quality, but has often yielded diverse information that is difficult to compare or trend. Public agencies are increasingly focused on performance improvement in healthcare, but misalignment and lack of strategic direction in quality initiatives further hinders our ability to foster system-wide transformation. The spectrum of work conducted by various agencies informed by quality measurement is broad, and bureaucratic structures foster competition between agencies while failing to incent alignment. Two recent initiatives in Massachusetts demonstrate the key challenges to achieving alignment. We convened healthcare-related public agencies, consumer and provider stakeholders to develop a set of quality measures for public reporting, improvement initiatives and payment incentives. The statewide quality advisory committee evaluated over 300 measures on factors such as ease of data collection, alignment with current state, federal, and private reporting efforts, and utility to providers and consumers. Consensus on priority areas, such as the Triple Aim, was apparent, but there was little alignment in measure utilization. Dispersion analysis of measures utilized in public and private sectors underscored the variation between programs. Particularly in public sector agencies, measurement priorities are set without an eye to alignment across settings. We then convened a multi-agency collaborative to develop the framework for a statewide quality strategy. Key challenges identified include a fragmented legacy data infrastructure, policies and laws that limit efficiency of data collection and sharing, resource constraints that limit data set linking, and competition for resources between agencies. Implementation of a quality strategy that aligns incentives, public reporting initiatives, and quality improvement programs will facilitate administrative simplification, reduce the reporting and analytical burden on providers and agencies, and inform future state, regional, and national measurement alignment efforts.

Learning Areas:

Administration, management, leadership
Conduct evaluation related to programs, research, and other areas of practice
Public health administration or related administration
Public health or related laws, regulations, standards, or guidelines
Public health or related organizational policy, standards, or other guidelines
Public health or related public policy

Learning Objectives:
Demonstrate the challenges of fragmentation in quality improvement and measurement initiatives. Formulate plans for alignment of complex multistakeholder agendas Identify mechanisms to translate shared priorities into collaborative actions across public sector agencies

Keyword(s): Quality Improvement, Data Collection

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the Massachusetts Department of Public Health staff leader for the development of a statewide quality strategy. In that role, along with a sister agency, I have led initiatives to drive alignment in quality improvement and measurement agendas. I have been a leader of a funded opportunity from the National Association of State Health Policy (NASHP) and the Office of the National Coordinator for Health Information Technology on quality alignment across 12 states.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.