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 innovationGoal of measureChallengesExamples or prototype
Measures for primary prevention of diabetesReinforce broad efforts to curb the epidemic of obesity and diabetesExtends accountability beyond health care system to community, schools, and work sitesPercent of work sites that offer health risk appraisal and health coach; percent schools with healthy food and adequate physical activity
Measures that include resource useEncourage efficient use of limited resourcesWhich 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 measuresEncourage timely treatments that are safe and beneficialValidation of measures needed; require detailed integrated data systemsPercent of diabetes patients at LDL goal or on moderate-dose statin
Partial credit measuresEncourage providers to focus on patients in the worst controlDeveloping consensus calibration for partial creditNCQA Diabetes Recognition Program
Adjust quality measures for patient characteristicsAvoid unintended consequences of lower pay for providers in low-SES settings, thus worsening health care disparitiesIdentify weighting factors such as patient health literacy or social deprivation index. Do not condone good poor careHEDIS already adjusted by insurance type
Patient-reported measuresIntegrate standard set of measures within EHR data structuresMeasure selection and validation; efficiency of data collectionCAHPS, NHS, PROMIS
Personalized risk-based measuresIdentify and prioritize clinical actions of greatest benefit to patients at encounterIncomplete evidence base to assess reversible risk reduction in all scenariosPrototype risk engines available (QRISK, UKPDS, Archimedes, Framingham, Wizard)