Table 3.
Examples of Existing Quality Indicators Relevant to Self-Reported Functional Status and Health-Related Quality of Life
| Developer | Set | NQF Endorsement | Quality Indicator Numerator | Description | Measures and Instruments | Information on Usability and Feasibilitya | Other Similar Measures |
|---|---|---|---|---|---|---|---|
| Screening and assessment: NCQA HEDIS 2012 | Prevention and Screening18 | NQF-endorsed 2009 | Percentage of adults aged ≥66 who had medication review, functional status assessment, and pain screening during the measurement year | Medical record review | Measurement tool is not defined; NCQA lists suggestions only, does not state that using a standardized tool is needed. | Burdensome, costly for plans; currently only applied to Medicare special needs plans. Good face validity for quality: variation among plans, improvement over time | Related measures in ACOVE and in Physician Consortium on Performance Improvemement/Physician Quality and Reporting System for dementia and osteoarthritis |
| Treatment and management: RAND | ACOVE19,b | IF a vulnerable elder receives the elements of a CGA that identifies a problem, THEN the problem should be addressed within 3 months | Medical record review | Functional status one element in CGA; not collected with self-reported outcomes | |||
| Follow-up and outcome: NCQA | HEDIS18 | Percentage of members whose health status was “better than expected,” “the same as expected” or “worse than expected” at the end of a 2-year period | Separate measures for physical and mental health status. Proxy respondents are allowed. | Collected using survey (random sample); Health Outcomes Survey, variant of Medical Outcomes Study 12-item Short-Form Survey; NCQA currently reconsidering measurement instrument | For Medicare Advantage organization level; risk-adjusted for participant characteristics, including age and comorbidity; does not differentiate well between health plans: few outliers | Related measures for functional status for home health care (Outcome and Assessment Information Set)—some measure improvement, some stability, some not worsening |
No existing relevant structural standards were identified.
a
Usability and feasibility refer to how the indicator can be applied, and usefulness for evaluating quality, in actual use.
b
Defined as vulnerable elder if scored ≥3 points on survey of physical functioning and age.
HEDIS = Healthcare Effectiveness Data and Information Set; NCQA = National Committee for Quality Assurance; NQF = National Quality Forum; CGA = Comprehensive Geriatrics Assessment; ACOVE = Assessing Care of Vulnerable Elders.