Standards and Subgroups: Why it’s Important to Account for Differences Across Patient Groups When Developing Quality Measures

There is a growing call to action across our nation’s health care system: increase the quality and value of care, improve patient outcomes, and control costs.

But that’s no small task. We have made significant progress in understanding what high-quality care should look like and, therefore, better ways to measure what’s working and where we need improvement. For many health policy thought leaders, however, there is no greater opportunity than looking to improving measures and, ultimately, care around patient subgroups.

In fact, as the proportion of older adults in America continues to grow—alongside an increasingly diverse patient population—ensuring quality measures and patient care recognize the specific needs of each group and subgroup has never been more important. Sue Peschin, president and CEO of the Alliance for Aging Research, noted during a conversation with the National Pharmaceutical Council (NPC), while “it’s always been important for clinicians to be involved” in the quality measurement process, “it’s becoming increasingly important for the patient voice to also be involved.”

Thankfully, policymakers, providers and health policy experts are expanding their focus beyond the walls of hospitals and doctors’ offices to ensure the patient perspective is included in the measure development process. And for good reason.

“Quality measures are important for patients,” shared Ms. Peschin, “because there isn’t a one-size-fits-all approach.” That doesn’t mean that we can’t develop standards of care and measures that can be broadly applied across patient populations—realistically, without this approach, developing measures that allow for apples-to-apples comparison and promote improvement would be impossible. What Ms. Peschin and a growing number of other health policy experts are emphasizing, is that even though the basics of quality treatment and diagnosis can be accurately captured in by measures, the effectiveness and appropriateness of those measures can often vary widely across patient populations.

For that reason, as Ms. Peschin pointed out, “it’s really important to address subgroups” and that means asking questions like “how are there differences across gender and race and age?” And according to Ms. Peschin, depending on the condition, those differences can “matter significantly in various patient populations—and that’s part of what quality measures can also capture, is really addressing those patient subgroups.”

The good news is that Ms. Peschin believes that this is one of the areas where measures and research can improve. By better addressing the concerns and needs that older patients, patients of various races and both men and women face in a clinical setting, physicians and other health professionals can ensure that they are able to focus on providing quality care to every patient. To highlight this need, Ms. Peschin shared an example outlining the importance of adequately including the older patient subgroup in research and in developing quality measures.

“If you look at the quality measure around atrial fibrillation [and anti-coagulation],” she shared, “age is a prohibitive factor because those patients [who are older] tend to have more of a tendency to bleed.” As such, in a clinical setting, there is often a concern that if you give a patient an anti-coagulant, it’s going to increase their risk of bleeding. “But the fact of the matter is that older patients are also at a higher risk of stroke”—and, as Ms. Peschin pointed out—“if they’re not under anti-coagulated properly, they’re at a much higher risk of stroke.”

What’s the answer? According to Ms. Peschin, at the end of the day, it’s a balancing act of taking into account these concerns, along with the particular needs of subgroups in a real-world, clinical setting, as we continue to reexamine how we develop measures and work to ensure they truly result in high-quality care for all patients. 

Want to learn more about quality measures? The University of Maryland School of Pharmacy and NPC have partnered to develop an online continuing education series, “Healthcare Quality: Measurement and Implications,” which provides a comprehensive overview of the health care quality landscape, including national priorities, and measure development, endorsement and implementation. The series includes two interactive modules, “Healthcare Quality in the United States,” and “Quality Measurement for the Pharmaceutical Industry,” for health care decision-makers (i.e., pharmacists, researchers, stakeholders and industry leaders).