Composite Measures: A New Gold Standard in Diabetes Care

28 Feb 2014
Type II diabetes has become a national public health threat. As a chronic disease, diabetes is one of the leading causes of death and disability. In the United States, approximately 25.8 million people (8.3 percent of the population) meet the criteria for a diagnosis of diabetes, and 79 million people have pre-diabetes or impaired glucose tolerance. According to the National Institutes of Health, diabetes is associated with long-term complications that affect almost every part of the body. The disease often leads to blindness, heart and blood vessel disease, stroke, kidney failure, amputations, and nerve damage.
As rates of diabetes increase, so, too, do associated direct and indirect costs. In 2007, diabetes cost $174 billion in the United States, both in terms of direct costs (such as hospitalizations, medical care, and treatment supplies) and indirect costs (such as disability payments and lost time from work). Increasing rates of diabetes in the population pose a significant challenge. Making sure those with diabetes receive optimal care is as complex as the disease itself. Many different indicators of health should be monitored on a regular basis. The goal of diabetes management is to keep levels of blood glucose, blood pressure, and cholesterol as close to the normal range as safely possible. Complications from diabetes can be prevented or at least delayed with appropriate monitoring and treatment.
The National Committee for Quality Assurance, a nonprofit dedicated to transforming health care, along with the Robert Wood Johnson Foundation, have strongly advocated for the use of composite measures and scores as a potential new gold standard for quality measurement in managing diabetes. The Institute of Medicine defines composite measures as “the bundling of measures for specific conditions to determine whether all critical aspects of care for a given condition have been achieved for an individual patient, thereby enhancing measurement to extend beyond tracking performance on separate measures.” That is, a composite score is a combined metric useful in assessing quality of care. Keeping diabetes under control in the doctor's office reduces the risks of other illnesses and future hospitalizations, and composite measures serve as checklists for doctors to make sure nothing is overlooked during a patient's visit. Some of the other common reasons to use composite measures include improving consumer comprehension, communicating with policy makers, and encouraging systematic improvements.
Aligning Forces for Quality communities that have implemented customized diabetes composite measures into their public reporting structures are already experiencing success in both clinical outcomes and improved performance. Synthesizing indicators of good diabetes management has helped simplify the challenges of chronic care management while improving efficiency and performance.
Read more about the work being done by Aligning Forces for Quality communities here.