DMAA Releases Consensus Guidelines on Measuring Outcomes
WASHINGTON, DC — The Disease Management Association of America (DMAA) today released widely anticipated consensus guidelines on recommended practices for measuring outcomes in chronic disease management programs.
The DMAA Outcomes Guidelines Report, which the association unveiled at its 8th Annual Disease Management Leadership Forum, in Denver, represents more than a year of work by DMAA leaders, its corporate and individual members and prominent external stakeholders, including the Agency for Healthcare Research and Quality (AHRQ) and the Joint Commission on Accreditation of Healthcare Organizations.
"These guidelines represent an unprecedented level of consensus among all stakeholders in chronic disease management and care coordination," DMAA Executive Director Tracey Moorhead said. "Throughout our process of developing the guidelines, we emphasized an inclusive, transparent process, and the final document reflects that."
In late 2005, DMAA developed a member survey to determine common industry practices for measuring disease management program outcomes. DMAA launched the survey in January 2006 and enlisted the University of Chicago's National Opinion Research Center to analyze and report on its results. That analysis identified common threads in outcomes measurement and areas of divergence. Through its Outcomes Steering Committee and committee work groups, DMAA worked to build consensus around practices for which less agreement existed.
"The challenge of this project—and the real testament to its success—was building consensus around those aspects of outcomes measurement not commonly approached in the same way by evaluators," said Donald E. Fetterolf, MD, MBA, co-chair of the Outcomes Steering Committee and a DMAA Board of Directors member. "It was these divergent evaluation methods, and the confusion they created among disease management purchasers, that provided the spark for this project."
Committee Co-Chair and Board Member Sue Jennings, PhD, agreed. "Working toward a consistent, reliable approach to measuring outcomes will help ease concerns about disease management's value," she said. "Our experience has been that disease management provides positive clinical and financial outcomes. Now we have a strong foundation for demonstrating that to others."
With its guidelines, DMAA successfully balanced the need for innovation in a still-evolving area of health care with the desirability of appropriate standardization, DMAA President Christobel Selecky said.
"Outcomes measurement is a natural area for standardization, but challenging because of the need to balance statistical validity with the practical realities of delivering programs to real people in real settings," she said. "Our goal was to convene all stakeholders to begin building a credible, standardized approach to measuring and demonstrating the humanistic, clinical and financial effectiveness of disease management.
"The report we release today represents a significant step toward that goal, and I commend the work of the committee and DMAA staff in getting us to this point. In the coming year, we will further refine and enhance these guidelines to reflect the continued learning and experience of all our partners in this endeavor."
The guidelines document provides background on the outcomes project, a "topline" recommendation summary and detailed narrative for each recommendation. It also includes literature references and an appendix of diagnostic and claims codes relevant to assessing clinical outcomes. DMAA offers the code list, which parallels that in its "Dictionary of Disease Management Terminology," as a starting point for clinical measures, which the association will explore in greater depth in 2007 under a second phase of the outcomes project.
Prominent among DMAA's recommended guidelines are use of pre-post study design that incorporates, whenever possible, an equivalent, concurrent comparison group; measurement methods for program identification, qualification for evaluation and Trend that incorporate the principle of equivalence between baseline and intervention groups; and a measurement period of one year for baseline and subsequent years. DMAA also recommends criteria and timeframes for inclusion in an evaluation study, look-back, definition of a member month and claims run-out.
For financial measures, DMAA recommends:
> assessing the financial impact of a program through health care cost outcomes, as measured by changes in total dollars or per-member-per-month charges for paid or allowed medical and pharmacy claims;
> use of a non-chronic population to calculate Trend.
> agreement on a mutually acceptable risk adjustment method, ideally a non-proprietary tool; and
> approaches to dealing with small sample sizes.
Beyond clinical and financial measures, DMAA offers guidance on measuring general mental and physical health status, participant satisfaction, lifestyle behaviors and medication adherence.
DMAA solicited comment on a draft of its guidelines at a Sept. 11, 2006, roundtable co-hosted by DMAA, AHRQ and the Joint Commission at AHRQ headquarters, in Gaithersburg, Md. Roundtable participants included prominent accrediting and quality organizations, corporate and business coalition representatives, actuaries and other stakeholders. DMAA also won comment and support from URAC, the National Committee for Quality Assurance and other quality leaders throughout the process. The DMAA Board unanimously approved the final guidelines at its Nov. 9 meeting.
A copy of the topline recommendations is available on the DMAA Web site, www.dmaa.org. For a copy of the full report, contact DMAA at (202) 737-5980 or [email protected].
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About DMAA
The Disease Management Association of America (DMAA) a non-profit membership association, represents all stakeholders in disease management and care coordination. DMAA promotes the role of disease management in raising the quality of care, improving health outcomes and reducing health care costs for individuals with chronic conditions. DMAA has more than 200 corporate and individual members representing all aspects of disease management and care coordination—from large health plans, disease management organizations and employers, to individual physicians, researchers and nurses. Learn more by visiting DMAA online at www.dmaa.org.