Consensus Report: Diabetes Performance Measures: Current Status and Future Directions

OVERVIEW: Just as treatment guidelines for diabetes care were at the forefront of medical guideline development,1 diabetes has been a prominent focus of performance measurement and quality improvement initiatives for well over a decade. However, the constraints of preelectronic health records (EHRs) data systems have consistently limited the clinical scope and sophistication of current diabetes quality measures. The U.S. health care system is nearing a tipping point in the use of more sophisticated EHR-based information systems, and widespread use of these systems will usher in a new era for diabetes quality measurement. New information system capabilities will enable improvements to existing measures and enable development of much more sophisticated measures that can accommodate personalization of clinical goals, patient preferences, and patient-reported data, thus moving both guidelines and measures toward personalization based on sophisticated assessment of the risks and benefits of certain clinical actions for a given patient at a given clinical encounter. To facilitate discussion of the future of performance measurement in diabetes in this era of rapid transition to EHRs, the American Diabetes Association (ADA) convened a consensus development conference in December 2010. Participating experts identified and discussed the following questions: 1. What is the evidence that measuring quality, benchmarking, and providing feedback or incentives improve diabetes care? 2. What are the limitations, burdens, and consequences (intended or unintended) of diabetes quality measures as currently structured? 3. What should be the role of shared decision making, patient preferences, and patient-reported data in quality measures? 4. What is the future of quality measurement in diabetes? 5. How can quality monitoring be integrated into population surveillance efforts?