Composite Approaches for Electronic Clinical Quality Measures

1. Composite Approaches for Electronic Clinical Quality Measures January 17, 2014

2. Types of Composites • Criterion-based composites: Require an assumption about what constitutes good or sufficient quality • All-or-none • Any-or-none • Absolute score composites: Summarize quality of care without assuming a standard of quality • Linear combination • Opportunity scoring • Regression-based • Options to amend the composite: • Level of aggregation (patient or component) • Threshold/benchmark scoring (variant of all-or-none) • Weighting • Source: Reeves, D., S.M. Campbell, J. Adams, P.G.Shekelle, E. Kontopantelis, and M.O. Roland. “Combining Multiple Indicators of Clinical Quality: An Evaluation of Different Analytic Approaches.” Medical Care, vol. 45, no. 6, June 2007, pp. 489–496.

3. Example Patient Population

4. Composite Approaches

5. All-or-None: Explanation and Example • Gives provider credit only if a patient meets the criteria for all components of the measure • From example patient population, only patient A received all screenings for which they were eligible

6. Any-or-None: Explanation and Example • Gives provider credit for patients who meet the criteria for at least one component of the measure • Somewhat of a reversal of “all-or-none” • From the example patient population, all 5 patients received at least one screening

7. Linear Combination: Explanation and Example • Average of scores across individual measure components • Gives provider partial credit for meeting the criteria for some but not all components of the measure

8. Opportunity Scoring: Explanation and Example • Ratio of instances when provider meets the measure criteria for a particular component of the measure to the number of “opportunities” to meet individual components

9. Regression Based: Explanation and Example • Weights items relative to their reliability or strength of association with a gold standard outcome (e.g., mortality) • Requires extensive data to derive and validate regression model An example score is not easy to illustrate for this approach. The weights for each measure component would be calculated using a regression model.

10. Modifiers in Developing Composite Approaches

11. Level of Aggregation: Explanation and Example • Composite approaches can combine individual measures at either the patient or component level • Patient level: all-or-none • Component level: opportunity scoring • Either: linear combination • Example: Component level linear combination

12. Threshold/Benchmark Scoring: Explanation and Example • A patient qualifies for the numerator if he or she meets a particular percentage of component measures. • Example: Patients must meet at least 70% of the components to quality for the numerator

13. Weighting: Explanation and Example • Gives more credit for meeting certain components • Example: The first and tenth screenings get twice the weight of the others