Protecting, maintaining and
improving the health of all Minnesotans
To: Members, PPG Advisory Committee
From: Stefan Gildemeister
Date: Nov. 14, 2012
Re: Selection of Quality Measures for Provider Peer Grouping System
During a discussion of the methodology for developing a composite measure of quality during our October
meeting, members asked for additional information about how the quality measures included in the composite
were initially selected.
Drawing on discussions that are reflected in publicly available material from the 2009 Provider Peer Grouping
Advisory Group and Technical Panel, following is a summary of considerations that contributed to the selection
of measures:
What was the basis for choosing the quality measures currently used to create the quality composite score?
The starting point for identifying quality measures for Provider Peer Grouping (PPG) was those measures in use
in the Statewide Quality Reporting and Measurement System (SQRMS), which draws from Hospital Compare,
AHRQ, NCQA, MN Community Measurement and other measure developers. The SQRMS set of measures were
selected beginning in 2008 after an environmental scan of measures in use, conducted by Dave Knutson for MN
Community Measurement. The measures were adopted in a state rule-making process that included
opportunities for public input.
In what venue was this discussed?
In 2009, first the Technical Panel and then the Advisory Committee discussed which quality measures to use.
They received input from other experts, including Christopher Tompkins of Brandeis University.
Members of the Technical Panel were: Dave Knutson (U of M); Bryan Dowd (U of M); Vicki Kunerth (DHS); Bill
Telleen (Park Nicollet); Jon Christianson (U of M); Allen Horn (CentraCare); Andy McCoy (Fairview); Jim Chase
(MNCM); Meg Hasbrouck (Allina); Boyd Lebow (BCBS); Robyn Carlson (Stratis); Tina Frontera (Medica); and
Kevin Larson (HCMC).
Members of the Advisory Group were: Charles Fazio (Medica); Jan Malcolm (Courage Center); Terry Cahill
(United Hospital District Clinics/MMA appointee); Timothy Crimmins (General Mills; MN Business Partnership
appointee); Peter Dehnel (All About Children/MMA appointee); Darryl Dykes (Twin Cities Spine Center/MMA
appointee); John Frederick (Preferred One/MCHP appointee); Keith Harvey (Virginia Regional Medical
Center/MHA appointee); Doug Hiza (BCBS/MCHP appointee); Nathan Moracco (SEGIP); Paul Mueller (Education
Minnesota); Christine Norton (Americans for Quality Health Care appointee); Karen Peed (DHS); Candace
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Simerson (Minnesota Eye Associates/MMGMA appointee); David Wessner (Park Nicollet/MHA appointee); and
Doug Wood (Mayo/MMA appointee).
What Did They Decide?
•
“The advisory group recognized the benefits of building on the progress of other quality projects, such
as the SQRMS and the Ambulatory Care Quality Alliance (AQA) (and)…looked to these projects as a
starting point to identify specific conditions that already have quality measurement endeavors in place.”
• The advisory group specifically stated that it “does not intend for new quality measures to be developed
and reported specifically for the sole purpose of provider peer grouping” but instead recommended
“using quality measures that providers are already collecting and submitting through other initiatives or
are available through the encounter database.”
• The Technical Panel recommended to the Advisory Group that “hospital quality measures should include
the entire set of hospital quality measures being planned for statewide reporting” and also include all
hospital safety indicators. This was based in part on recommendations from Christopher Tompkins of
Brandeis University, who authored the article “Measuring Outcomes and Efficiency in Medicare ValueBased Purchasing” (Health Affairs 28, no. 2 (2009): w251-w261). The article proposed the use of clinical
outcome measures to the extent they are available, combining information from multiple measures to
curtail the effects of “noise” from unexplained variability.
• Inclusion of the AHRQ ambulatory care sensitive conditions measures was based on a recommendation
by Dave Knutson, a member of the Technical Panel. At the time, the measures required another year of
development, but the Technical Panel felt that the ambulatory care sensitive readmissions were “an
important opportunity to measure quality.”
What other input did they receive?
•
The Advisory Group also recommended disaggregating the AHRQ hospital inpatient composite measures
and the physician composite measures.
• “In order to maximize opportunities to measure quality, the advisory group recommends not using any
pre-constructed composite quality measures, such as the optimal care D5 measure for diabetes that is
used by MN Community Measurement, but rather including each of the independent component
measures that comprise the pre-constructed composites.”
Will the quality measures evolve over time?
Yes, both the legislature, in the statutes creating SQRMS and PPG, and measurement experts anticipate that the
quality measure sets will evolve over time in response to developments in quality measurement science.
Minnesota’s local initiatives as part of SQRMS and beyond will likely contribute to this evolution, as will many
other ongoing efforts at the national level.
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