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Opportunities for Quality Measurement to Improve the Value of Care for Patients With Multiple Chronic ConditionsQuality Measurement for Multiple Chronic Conditions

Arjun Venkatesh, MD, MBA, MHS*; Kate Goodrich, MD, MHS**; and Patrick H. Conway, MD, MSc**
[+] Article, Author, and Disclosure Information

* Current Robert Wood Johnson Foundation Clinical Scholar.

** Former Robert Wood Johnson Foundation Clinical Scholar.

This article is part of the Annals supplement “RWJF Clinical Scholars in Pursuit of the Value Proposition: Evaluations of Low-Cost Innovations for Prevention and Management of Conditions.” The Robert Wood Johnson Foundation provided funding for publication of this supplement. Carol M. Mangione, MD, MPH (co-director of the RWJF Clinical Scholars Program at the University of California, Los Angeles); Jaya K. Rao, MD, MHS (Annals Deputy Editor); and Christine Laine, MD, MPH (Annals Editor in Chief), served as editors for this supplement.


From Yale School of Medicine, New Haven, Connecticut; Center for Clinical Standards and Quality, Centers for Medicare & Medicaid Services, Baltimore, Maryland; George Washington University School of Medicine, Washington, DC; and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.

Grant Support: By the Robert Wood Johnson Foundation Clinical Scholars Program (Dr. Venkatesh).

Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-3014.

Requests for Single Reprints: Arjun Venkatesh, MD, MBA, MHS, Department of Emergency Medicine, Yale University School of Medicine, 464 Congress Street, Suite 260, New Haven, CT 06519; e-mail, arjun.venkatesh@yale.edu.

Current Author Addresses: Dr. Venkatesh: Department of Emergency Medicine, Yale University School of Medicine, 464 Congress Street, Suite 260, New Haven, CT 06519.

Drs. Goodrich and Conway: Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore, MD 21244.

Author Contributions: Conception and design: A. Venkatesh, K. Goodrich, P.H. Conway.

Analysis and interpretation of the data: P.H. Conway.

Drafting of the article: A. Venkatesh, K. Goodrich, P.H. Conway.

Critical revision of the article for important intellectual content: A. Venkatesh, K. Goodrich, P.H. Conway.

Final approval of the article: A. Venkatesh, K. Goodrich, P.H. Conway.

Administrative, technical, or logistic support: A. Venkatesh, P.H. Conway.

Collection and assembly of data: A. Venkatesh, P.H. Conway.


Ann Intern Med. 2014;161(10_Supplement):S76-S80. doi:10.7326/M13-3014
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Quality measurement efforts have not historically focused on patients with multiple chronic conditions (MCCs), despite them comprising one quarter of the population and two thirds of health care spending. The Patient Protection and Affordable Care Act (ACA) creates several mechanisms for the Centers for Medicare & Medicaid Services (CMS) to transform quality measurement into an organized enterprise designed to support clinicians caring for this vulnerable population. This article highlights 3 emerging policy opportunities for CMS to guide public and private quality measurement efforts for patients with MCCs. First, it discusses infusing an MCC framework into measure development to promote patient-centered, as opposed to single-disease–specific, performance measurement. Second, it describes the importance of using common performance measures for individual clinicians, hospitals, and communities to accelerate meaningful improvement in the prevention and management of chronic conditions across local populations. Finally, the need for longitudinal measurement as a foundation for sustained quality improvement is presented. The ACA's expansion of insurance access and portability necessitates collaborative alignment of chronic condition quality measurement efforts between public and private programs to develop a high-value lifelong health system.

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