title: The feasibility and value of new measures showing patterns of quality for patients with 3 chronic conditions.
abstract: The aim of this study was to create new measures of quality that combine individual service measures. Using an all-or-none approach, we identify 5 levels of care reflecting the extent to which optimal patterns of service were obtained by patients with asthma, diabetes, and heart failure. We also assess the feasibility of these levels-of-care measures and their potential value in quality improvement efforts. The study was designed to analyze claims data to reflect patterns of services used in a single metropolitan market of about 1 million residents in the northeastern United States. More than 80,000 patients insured over 4 years (1994-1997) had claims with 1 or more of 3 chronic conditions. The analysis showed that the measures discriminated effectively among groups of patients with the 3 chronic conditions and highlighted areas to target quality improvement efforts. Although the numbers vary by year, for two of the diagnoses, most patients were in the lowest categories (59%-75%), and for the third, 40% were in these categories. Few were in the highest category. Most patients were in the same category from one year to the next. The levels-of-care approach to quality measurement can help caregivers and policy makers find methods for avoiding unnecessary utilization and expenditures while raising--not lowering--the probability that utilization patterns will conform to condition-specific recommended care.
authors.affiliation: Strategy and Policy Department and Health Sector Management Program, Boston University School of Management, Boston, Mass 02215, USA. sdavidso@bu.edu
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Davidson
authors.forename: Michael
authors.initials: M
authors.lastname: Shwartz
authors.forename: Randall S
authors.initials: RS
authors.lastname: Stafford
mesh_terms: D000368:Aged; D002908:Chronic Disease; D015897:Comorbidity; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007345:Insurance Claim Review; D007348:Insurance, Health / Q000145:classification; D008297:Male; D008875:Middle Aged; D009511:New England; D010818:Practice Patterns, Physicians' / Q000145:classification; D011787:Quality of Health Care / Q000592:standards*