Last week I attended the first annual meeting of the Long-Term Quality Alliance and listened to Gregg Pawlson (a geriatrician and executive with NCQA) talk about quality measurement. Right now, quality measurement does too little to drive practice towards quality care because it is based only on things that are “feasible,” or easy to measure—like what gets coded on medical bills. Pawlson observed that while feasibility must be one of the watchwords of quality measurement for now, in the near future electronic medical records should allow us to move beyond billing codes to gather real clinical data for more important quality measurement, including key care processes and outcomes.
I sure hope so. Because those who have looked beyond the dim illumination of current billing-based “quality measures” and searched in the darkness where real processes of clinical care can found have found that the situation is grave. The ACOVE (Assessing Care of Vulnerable Elders) process, while laborious, looks at clinical care where it really happens – in offices and charts – rather than in bills and therefore has a better chance of driving meaningful quality improvement. Readers of Health AGEnda know that I am a big fan of this work, begun at RAND by outstanding clinician-researchers including Neil Wenger, David Solomon, David Reuben, and many others. I believe that ACOVE is an example of what we need in elder care: high quality evidence about essential clinical practices that are sensibly related to real health outcomes and show how we could (often easily) do better for older people. ACOVE is a blessing.
One of the leaders of the ACOVE program is Neil Wenger, MD, a faculty member in General Internal Medicine at UCLA and a researcher at RAND who I have cited in my posts. However, in his talk to the Maxwell School of Public Policy at Syracuse University (another treasure I found last fall at GSA), he really outdid himself in delivering one of the most accessible (and provocative) descriptions of this research program I have ever read. He asks, “Do We Want to Measure the Quality of Care for Vulnerable Older People?” Given the lack of attention to the ACOVE work, I understand his frustration.Continue reading…
