Table 1.

Summary of selected opportunities for new or improved diabetes performance measures based on increasingly sophisticated electronic data systems and including patient-reported measures

Opportunity for innovation	Goal of measure	Challenges	Examples or prototype
Measures for primary prevention of diabetes	Reinforce broad efforts to curb the epidemic of obesity and diabetes	Extends accountability beyond health care system to community, schools, and work sites	Percent of work sites that offer health risk appraisal and health coach; percent schools with healthy food and adequate physical activity
Measures that include resource use	Encourage efficient use of limited resources	Which providers are accountable for resource use when many provide care?	Percent of generics used when generic available; ratio of resource use to quality of care
Clinical action measures	Encourage timely treatments that are safe and beneficial	Validation of measures needed; require detailed integrated data systems	Percent of diabetes patients at LDL goal or on moderate-dose statin
Partial credit measures	Encourage providers to focus on patients in the worst control	Developing consensus calibration for partial credit	NCQA Diabetes Recognition Program
Adjust quality measures for patient characteristics	Avoid unintended consequences of lower pay for providers in low-SES settings, thus worsening health care disparities	Identify weighting factors such as patient health literacy or social deprivation index. Do not condone good poor care	HEDIS already adjusted by insurance type
Patient-reported measures	Integrate standard set of measures within EHR data structures	Measure selection and validation; efficiency of data collection	CAHPS, NHS, PROMIS
Personalized risk-based measures	Identify and prioritize clinical actions of greatest benefit to patients at encounter	Incomplete evidence base to assess reversible risk reduction in all scenarios	Prototype risk engines available (QRISK, UKPDS, Archimedes, Framingham, Wizard)