David H Jiang et al. published an article in Health Affairs last month arguing for a set of diabetes quality measures that are actually linked to optimal diabetes health. Composite measures that include “all-or-nothing” components will incentivize providers to focus on patients who are most likely to achieve the measure rather than those who would benefit the most clinically. This would also adversely affect patients with socioeconomic barriers to optimal health, as those patients are more likely to have multiple unmet measures or not meet a measure that is more difficult to achieve (e.g., smoking cessation). A more equitable approach would be support higher-risk (and higher-need) patients who fall short of multiple components of a composite measure or deviate far from specified thresholds.
The authors suggest alternative metrics:
- Prescription of GLP-1 receptor agonists to patients with atherosclerotic cardiovascular disease
- Prescription of SGLT-2 inhibitors to patients with heart failure or diabetic kidney disease
- Cardiovascular event rate
- Progression of diabetic kidney disease
- Lower extremity complications
- Patient out-of-pocket costs related to diabetes
- Patient-reported treatment burden
- Cost of care per patient per year
- Hospitalization and ED visits for hypoglycemia
- Hospital-acquired conditions
- Patient-reported quality-of-life