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7. Quality Improvement Measurement of Outcomes for People with Disabilities Closing the Quality Gap: Revisiting the State of the Science

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7. Quality Improvement Measurement of Outcomes for People with Disabilities Closing the Quality Gap: Revisiting the State of the Science Evidence Report/Technology Assessment Number 208 7. Quality Improvement Measurement of Outcomes for People With Disabilities Closing the Quality Gap: Revisiting the State of the Science Agency for Healthcare Research and Quality Evidence-Based Practice Advancing Excellence in Health Care • www.ahrq.gov Evidence Report/Technology Assessment Number 208 7. Quality Improvement Measurement of Outcomes for People With Disabilities Closing the Quality Gap: Revisiting the State of the Science Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 540 Gaither Road Rockville, MD 20850 www.ahrq.gov Contract No. 290-2007-10064-I Prepared by: Minnesota Evidence-based Practice Center Minneapolis, MN Investigators: Mary Butler, Ph.D. Robert L. Kane, M.D. Sheryl Larson, Ph.D. Molly Moore Jeffery, M.P.P. Mike Grove AHRQ Publication No. 12(13)-E013-EF October 2012 This report is based on research conducted by the Minnesota Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2007-10064-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients. This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied. This document is in the public domain and may be used and reprinted without special permission except those copyrighted materials that are clearly noted in the document. Further reproduction of those copyrighted materials is prohibited without the specific permission of copyright holders. Persons using assistive technology may not be able to fully access information in this report. For assistance contact [email protected]. None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report. Suggested citation: Butler M, Kane RL, Larson S, Jeffery MM, Grove M. Quality Improvement Measurement of Outcomes for People With Disabilities. Closing the Quality Gap: Revisiting the State of the Science. Evidence Report/Technology Assessment No. 208. (Prepared by the Minnesota Evidence-based Practice Center under Contract No. 290-2007-10064-I.) AHRQ Publication No. 12(13)-E013-EF. Rockville, MD: Agency for Healthcare Research and Quality; October 2012. www.effectivehealthcare.gov/reports/final.cfm. ii Preface The Agency for Healthcare Research and Quality (AHRQ), through its Evidence-based Practice Centers (EPCs), sponsors the development of evidence reports and technology assessments to assist public- and private-sector organizations in their efforts to improve the quality of health care in the United States. The reports and assessments provide organizations with comprehensive, science-based information on common, costly medical conditions, and new health care technologies and strategies. The EPCs systematically review the relevant scientific literature on topics assigned to them by AHRQ and conduct additional analyses when appropriate prior to developing their reports and assessments. In 2004, AHRQ launched a collection of evidence reports, Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies, to bring data to bear on quality improvement opportunities. These reports summarized the evidence on quality improvement strategies related to chronic conditions, practice areas, and cross-cutting priorities. This evidence report is part of a new series, Closing the Quality Gap: Revisiting the State of the Science. This series broadens the scope of settings, interventions, and clinical conditions, while continuing the focus on improving the quality of health care through critical assessment of relevant evidence. Targeting multiple audiences and uses, this series assembles evidence about strategies aimed at closing the “quality gap,” the difference between what is expected to work well for patients based on known evidence and what actually happens in day-to-day clinical practice across populations of patients. All readers of these reports may expect a deeper understanding of the nature and extent of selected high-priority quality gaps, as well as the systemic changes and scientific advances necessary to close them. AHRQ expects that the EPC evidence reports will inform consumers, health plans, other purchasers, providers, and policymakers, as well as the health care system as a whole, by providing important information to help improve health care quality. We welcome comments on this evidence report or the series as a whole. Comments may be sent by mail to the Task Order Officer named in this report to: Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850, or by email to [email protected]. Carolyn M. Clancy, M.D. Jean Slutsky, P.A., M.S.P.H. Director Director, Center for Outcomes and Evidence Agency for Healthcare Research and Quality Agency for Healthcare Research and Quality Stephanie Chang, M.D., M.P.H. Christine Chang, M.D., M.P.H. Director Task Order Officer, Evidence-based Practice Program Closing the Quality Gap Series Center for Outcomes and Evidence Center for Outcomes and Evidence Agency for Healthcare Research and Quality Agency for Healthcare Research and Quality Kathryn McDonald, M.M. Harvey Schwartz, Ph.D., M.B.A. Lead EPC Investigator and Associate Editor, Office of Extramural Research, Education, Closing the Quality Gap Series and Priority Populations Stanford University Agency for Healthcare Research and Quality Suchitra Iyer, Ph.D. Task Order Officer Center for Outcomes and Evidence Agency for Healthcare Research and Quality iii Acknowledgments The authors gratefully acknowledge the following individuals for their contributions to this project: Charles Lakin, Brian Abery, and Lynda Anderson for generously sharing the Institute for Community Integration’s resources and accumulated knowledge and experience, and Mike Grove and Andrea Wysocki for their search and screening assistance. Technical Expert Panel Valerie J. Bradley, M.A. Allen W. Heinemann, Ph.D., ABPP, RFP, FACRM Human Services Research Institute Northwestern University Cambridge, MA Chicago, IL Sara Galantowicz, M.P.H. Lisa Iezzoni, M.D., M.Sc. Thomson Reuters (Healthcare) Inc. Massachusetts General Hospital Cambridge, MA Boston, MA Charlene Harrington, Ph.D. Margaret Stineman, M.D. Institute for Health and Aging University of Pennsylvania San Francisco, CA Philadelphia, PA Peer Reviewers Valerie J. Bradley, M.A. Mitchell La Plant, Ph.D. Human Services Research Institute University of California Cambridge, MA San Francisco, CA Sara Galantowicz, M.P.H. Elizabeth Rasch, P.T., Ph.D. Thomson Reuters (Healthcare) Inc. NIH Clinical Center Cambridge, MA Bethesda, MD Charlene Harrington, Ph.D. Margaret Stineman, M.D. Institute for Health and Aging University of Pennsylvania San Francisco, CA Philadelphia, PA Gale Whiteneck Craig Hospital Englewood, CO iv Quality Improvement Measurement of Outcomes for People With Disabilities Closing the Quality Gap: Revisiting the State of the Science Structured Abstract Objective. To examine how health care outcomes for general medical care have been assessed for people with disabilities within the rubrics of care coordination and quality improvement. Data Sources. MEDLINE®, PsychINFO, ERIC, and CIRRIE through March 27, 2012; hand searches of references from relevant literature and journals. A search of high-quality gray literature sources was also conducted. Review Methods. We included all forms of disability except severe and persistent mental illness for all age groups in outpatient and community settings. We focused on outcomes, patient experience, and care coordination process measures. We looked for generic outcome measures rather than disability-condition–specific measures. We also looked for examples of outcomes used in the context of disability as a complicating condition for a set of basic service needs relevant to the general population, and secondary conditions common to disability populations. Two independent reviewers screened all articles; disagreements were resolved through consensus. Included articles were abstracted to evidence tables and quality-checked by a second reviewer. Data synthesis was qualitative. Results. A total of 15,513 articles were screened; 15 articles were included for general outcome measures and 44 studies for care coordination. A large number of outcome measures have been critically assessed and mapped to the International Classification
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