Your next patient is a 67-year-old Medicare beneficiary with corticosteroid-dependent ulcerative colitis. Despite 4 months of maximally dosed mesalamine, his colitis flares with prednisone taper below 20 mg daily. Hepatitis B serologies and tuberculin skin test were negative 10 months ago. Which of the following do you recommend?
A. Steroid-sparing therapy initiation
B. Repeat latent tuberculosis screening in anticipation of anti–tumor necrosis factor (TNF) therapy
C. Bone loss assessment
D. Pneumococcal vaccination
E. Tobacco use screening
Quality measure reporting is a costly undertaking, with medical practices spending an average of 15.1 hours per physician per week ($40,069 per physician annually) dealing with external quality measures.2 How did this expensive alphabet soup of quality measure reporting arise and how does it impact inflammatory bowel disease (IBD) care?
Why are IBD quality measures needed?
What makes a good quality measure?
Quality must be defined and measured before it can be improved. This is easier said than done, especially for IBD where a gold standard in “ideal care” is ill defined and continually evolving as new research emerges. Nonetheless, hundreds of health care quality measures have been proposed. Desirable quality measure attributes should satisfy three broad categories: importance, scientific soundness, and feasibility.10 Quality measures should address relevant and important aspects of health that are highly prevalent and for which evidence indicates a need for improvement. There should be strong evidence supporting the beneficial impact of adhering to a given measure.
Quality measures are commonly classified as process measures or outcome measures. Process measures (“doing the right thing”) are steps taken by providers in the care of an individual patient. These often derive from evidence-based best practices. Outcome measures (“having the desired result”) identify what happens to patients as a result of care received.8 Outcome measures may be more meaningful, but there are limitations in using them to study quality of IBD care. For example, factors beyond physician control affect patient outcomes and long delays may exist between care decisions and subsequent outcomes (e.g., surgery, malnutrition).8
What IBD quality measures already exist?
Expert panels from the AGA and the Crohn’s & Colitis Foundation of America (CCFA) produced IBD quality measure sets comprising mostly process measures (Table 1). The original 10 AGA measures released in 2011 address aspects of disease assessment, treatment, complication prevention, and health care maintenance.12 They include seven IBD-specific measures, three cross-cutting measures – defined by Centers for Medicare & Medicaid Services (CMS) as being broadly applicable across multiple clinical settings – and two inpatient measures. A major goal of the AGA measures was to facilitate quality reporting to the former PQRS program.