title: Health-weighted Composite Quality Metrics Offer Promise to Improve Health Outcomes in a Learning Health System.
abstract: Health system leaders sometimes adopt quality metrics without robust supporting evidence of improvements in quality and/or quantity of life, which may impair rather than facilitate improved health outcomes. In brief, there is now no easy way to measure how much "health" is conferred by a health system. However, we argue that this goal is achievable. Health-weighted composite quality metrics have the potential to measure "health" by synthesizing individual evidence-based quality metrics into a summary measure, utilizing relative weightings that reflect the relative amount of health benefit conferred by each constituent quality metric. Previously, it has been challenging to create health-weighted composite quality metrics because of methodological and data limitations. However, advances in health information technology and mathematical modeling of disease progression promise to help mitigate these challenges by making patient-level data (eg, from the electronic health record and mobile health (mHealth) more accessible and more actionable for use. Accordingly, it may now be possible to use health information technology to calculate and track a health-weighted composite quality metric for each patient that reflects the health benefit conferred to that patient by the health system. These health-weighted composite quality metrics can be employed for a multitude of important aims that improve health outcomes, including quality evaluation, population health maximization, health disparity attenuation, panel management, resource allocation, and personalization of care. We describe the necessary attributes, the possible uses, and the likely limitations and challenges of health-weighted composite quality metrics using patient-level health data.
authors.affiliation: New York University School of Medicine;
authors.forename: Scott
authors.initials: S
authors.lastname: Braithwaite
authors.affiliation: New York City Health and Hospitals Corporation.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Stine
references.citation: Health Aff (Millwood). 2012 Nov;31(11):2441-50
references.pmid: 23129674
references.citation: JAMA. 2012 Feb 1;307(5):441-2
references.pmid: 22298662
references.citation: Am Fam Physician. 2006 Oct 1;74(7):1209-10, 1212
references.pmid: 17039759
references.citation: Ann Intern Med. 2004 Jan 6;140(1):54-9
references.pmid: 14706973
references.citation: Cancer. 2009 Dec 15;115(24):5610-1
references.pmid: 19957353
references.citation: Health Aff (Millwood). 2008 Sep-Oct;27(5):1429-41
references.pmid: 18780934
references.citation: J Eval Clin Pract. 2011 Apr;17(2):341-3
references.pmid: 21114716
references.citation: J Eur Acad Dermatol Venereol. 2013 Jun;27(6):763-70
references.pmid: 22631875
references.citation: Med Care. 2012 Dec;50(12):1109-18
references.pmid: 22929993
references.citation: Chest. 2012 Feb;141(2):300-7
references.pmid: 22315113
references.citation: JAMA. 2013 Feb 6;309(5):449-50
references.pmid: 23385269
references.citation: JAMA. 2005 Aug 10;294(6):716-24
references.pmid: 16091574
references.citation: Ann Intern Med. 2013 Aug 6;159(3):161-8
references.pmid: 23922061
references.citation: Value Health. 2012 Sep-Oct;15(6):843-50
references.pmid: 22999134
references.citation: Cancer. 2004 Sep 1;101(5 Suppl):1214-28
references.pmid: 15316908