Patient-Centered Quality & Performance Measurement

AIR works to bridge research and practice by adapting evidence-based theory to real-world settings and challenges. Current performance measurement approaches too often don’t align with patient and family needs, preferences, and values. When this happens, organizations run the risk of providing information that patients do not find relevant or useful when making care decisions. Health care organizations also can overlook ways to drive quality and safety improvements that matter to patients. Ultimately, to reorient the healthcare system to center on patients’ needs, preferences, and values, measurement must reflect what matters to patients.

With support from the Robert Wood Johnson Foundation, AIR launched small-scale pilots to demonstrate how to implement the AIR-developed Principles for Making Health Care Measurement Patient-Centered in real-world settings. The five principles offer a vision of measurement that is patient-driven, holistic, transparent, comprehensible and timely, and co-created with patients, while driving meaningful change toward better care, better health, and lower costs.

Over the last decade, AIR has led seminal work in developing patient-centered outcome and performance measures from patient-reported data. AIR’s measure specification, testing, implementation, and maintenance work for the Centers for Medicare & Medicaid Services, the Agency for Healthcare Research and Quality (AHRQ), and the National Institutes of Health includes an array of patient-reported measures, including:

  • Care coordination
  • Experience of care, such as Consumer Assessment of Healthcare Providers and Systems (CAHPS®) surveys
  • Health status and quality of life, such as the Patient-Reported Outcome Measurement Information System (PROMIS®)
  • Population/community health
  • Patient safety
  • Person- and caregiver-centered experiences and outcomes

An example of AIR’s expertise across the full measure development lifecycle is the CAHPS Home- and Community-Based Services (HCBS CAHPS) Survey, which elicits feedback from Medicaid enrollees about the quality of the long-term services and supports they receive in the community. And in partnership with the Mayo Clinic, AIR developed the CAHPS Cancer Care Survey for AHRQ, which assesses the experiences of adult patients with cancer treatment provided in outpatient and inpatient settings, including independent community oncology practices, cancer centers at community hospitals, and cancer centers at academic medical centers.

Latest Work

Illustration of AIR expert Yael Harris
21 Apr 2020
Q & A

Meet the Expert: Yael Harris

Yael Harris leads research projects to advance access, quality, payment reform, and other policies to transform health care delivery. She is involved in a wide-ranging set of health-related projects, including the Agency for Healthcare Research and Quality Quality Indicators, the Strong Start for Mothers and Newborns Evaluation, and Project Talent. Learn more about her and her work in this Q&A.
4 Feb 2020 | 12:00 PM - 1:00 PM
Event

Putting Patient-Centered Measurement Principles Into Practice

With funding from the Robert Wood Johnson Foundation, AIR funded four small-scale pilot projects to implement the five principles for patient-centered measurement. These principles define the essential elements of patient-centered measurement as: co-created, patient-driven, holistic, transparent, and comprehensible and timely. On Tuesday, Feb. 4, AIR hosted an online panel discussion with the pilot teams.
Project

CAHPS® Home- and Community-Based Services (HCBS CAHPS) Survey

The CAHPS Home and Community-Based Services Survey (HCBS CAHPS) elicits feedback from Medicaid enrollees about the quality of the long-term services and supports they receive in the community. As a subcontractor on this Centers for Medicare & Medicaid Services project, AIR led qualitative research to develop survey items in the following domains: shared decisionmaking, personal safety, planning time and activities, transportation, unmet needs, staff helpfulness, and staff listening and communications skills.
Project

Cross-Sector Measurement to Advance Health Equity

What features of measurement drive alignment across sectors for community well-being? With funding from the Robert Wood Johnson Foundation, AIR is exploring measurement as a catalyst for alignment across the healthcare, public health, and social service sectors.
Project

Patient-Centered Measurement Pilot Projects

AIR developed the Principles for Making Health Care Measurement Patient-Centered to offer a vision of measurement that is patient-driven, holistic, transparent, comprehensible and timely, and co-created with patients. With support from the Robert Wood Johnson Foundation, AIR launched small-scale pilots to demonstrate how to implement the principles in real-world settings.
Project

Agency for Healthcare Research and Quality (AHRQ) Quality Indicators

The AHRQ Quality Indicators (QIs) are standardized, evidence-based measures of healthcare quality that can be used with readily available hospital inpatient administrative data to measure and track clinical performance and outcomes. AIR provided outreach and dissemination support to educate hospitals, state hospital associations, and other stakeholders about the AHRQ QIs and QI software.
Project

Qualifying Patient-Reported Outcome Measures (PROMs) for Assessing Fatigue

Building on work as the PROMIS Network Center, AIR is leading efforts to obtain Food and Drug Administration qualification of the PROMIS fatigue measure for use in clinical trials of therapy for myalgic encephalomyelitis/chronic fatigue syndrome. AIR will collaborate with a patient co-investigator and the Bateman Horne Center for ME/CFS and Fibromyalgia to produce evidence related to the psychometric reliability and validity of the PROMIS fatigue measure for patients with ME/CFS.
Project

Comprehensive Primary Care Plus (CPC+)

AIR led a world-class team of quality experts to measure patient experiences in the largest undertaking to date by the Centers for Medicare & Medicaid Services (CMS) to transform primary care practice in America—the Comprehensive Primary Care Plus (CPC+) model. Through the CPC+ model, CMS is simultaneously testing service delivery and payment innovations with more than 3,000 primary care practices.
17 Jul 2017
Spotlight

Placing Patients at the Center of Health Care

Longstanding debate about how to ensure and measure excellent healthcare abounds. Increasingly health professionals, insurers, researchers and, indeed, patients and families, are recognizing that health care is better when patients’ needs are placed at the center of the decision-making process. How can we capture patient voices in ways that can improve healthcare delivery, cost, and outcomes? How do we measure what matters to the person who becomes a patient when illness strikes?
Infographic: Health Care Spending: How does the U.S. compare to other countries? Total health spending per person, 2015 (U.S. dollars)Italy 3272 OECD Average 3814 United Kingdom 4003 Japan 4150 France 4407 Canada 4608 Germany 5267 United States 9451
21 Jun 2017
Infographic

What Is the Value of Patient-Reported Outcomes?

Americans have poor health outcomes despite spending much more than other industrialized nations on health care. Patient-reported outcomes promote public health and improve the quality of health care.

San Keller
21 Jun 2017
Video

Long Story Short: What is the Value of Patient-Reported Outcomes?

Patient-reported outcomes measure patients’ direct experiences of their health condition and health care. San Keller explains the value of such outcomes in promoting public health and improving the quality of health care.
10 Apr 2017
Report

Principles for Making Health Care Measurement Patient-Centered

Patient-centered measurement involves partnering with patients in a meaningful way to decide what we measure, how we measure it, and how we report and use the results of measurement. Principles for Making Health Care Measurement Patient-Centered offers a vision of measurement that is patient-driven, holistic, transparent, comprehensible and timely, and co-created with patients. These principles, and related examples, address a critical gap in measuring health care by placing patient preferences at the center.
13 Dec 2016
Blog Post

Taking a Page from Education to Improve Healthcare

Education has borrowed many ideas from the medical field. Now a new initiative shows the exchange isn’t just a one-way street. Bookmarking, a widely-used method for establishing student proficiency levels in major education tests—such as the National Assessment of Educational Progress—is being adapted to healthcare so patients and their families can better communicate the severity of symptoms. In this blog post Michelle Langer and Ellen Schultz explain this innovative new approach.
Project

Principles for Making Healthcare Performance Measurement More Patient-Centered

"How would health care measurement look different if it reflected what patients say they need and want?" In September 2016, AIR hosted a two-day, in-person meeting devoted to answering this question, exploring ways to drive progress toward patient-centered measurement—health care measurement driven by patients’ expressed preferences, needs, and values that informs progress toward better health, better care, and lower costs.
7 Aug 2015
Toolkit

Tool to Improve Health Insurance Marketplace Consumer Experiences

How can the Health Insurance Marketplaces improve consumers’ experiences when shopping for, selecting, and enrolling in affordable health plans during future open-enrollment periods? To help answer this question, AIR developed the Marketplace Survey Improvement Guide. The Guide provides seven evidence-based strategies that will help Marketplaces improve the consumer experience by giving consumers accurate and relevant information in a timely manner and helping consumers understand and use that information.
Project

Public Quality and Cost Reporting on California Health Plans and Medical Groups

California's Health Care Quality Report Cards are designed to help inform and educate consumers about their rights and responsibilities as health plan enrollees and to educate them about how to use services offered by their health plans. AIR assists the National Committee on Quality Assurance in supporting the California Office of the Patient Advocate in publicly reporting clinical performance and patient experience data for the state's largest health plans and more than 200 medical groups.
Project

Understanding Sickle Cell Patients’ Health-Related Quality of Life

An estimated 90,000 Americans have sickle cell disease (SCD), and increased infant screening, improved disease management throughout childhood, and better therapies have all led to much longer lives for people with this rare blood disorder. With funding from the National Heart, Lung and Blood Institute, AIR led a team of researchers to develop an Sickle Cell Disease Patient-Reported Outcome measurement system called ASCQ-Me that would help to bridge the gaps in understanding about adult patients’ experiences and long-term needs.
22 Oct 2014
Brief

A Little Knowledge Is a Risky Thing: Wide Gap in What People Think They Know About Health Insurance and What They Actually Know

Under the 2010 Affordable Care Act, millions of Americans gained health coverage in 2014. Coverage is key to accessing affordable, high-quality care, but consumers who struggle to understand how health insurance works and how to estimate out-of-pocket costs are at risk of going without needed care even if they are covered. This brief outlines identifies what health insurance aspects pose the greatest problems for consumers, which groups need more assistance to enroll and use benefits, and what topics and skills consumer-counseling efforts should focus on.
14 Oct 2014
Report

Development of the Health Insurance Literacy Measure (HILM): Conceptualizing and Measuring Consumer Ability to Choose and Use Private Health Insurance

Understanding health insurance is central to affording and accessing health care in the United States. Efforts to support consumers in making wise purchasing decisions and using health insurance to their advantage would benefit from the development of a valid and reliable measure to assess health insurance literacy. This article reports on the development of the Health Insurance Literacy Measure, a self-assessment measure of consumers' ability to select and use private health insurance.
Project

Measuring Health Insurance Literacy

Health insurance coverage is key to accessing affordable, high-quality care. But do most Americans have the knowledge and skill they need to navigate or get the most out of their insurance plans? To answer this question, AIR researchers developed The Health Insurance Literacy Measure©, which consists of 21 self-report questions assessing self-confidence and behaviors associated with choosing and using health insurance.
Project

Testing Evalue8 Measures for Consumers

By 2016, consumers shopping on the online Health Insurance Marketplaces created under the Affordable Care Act will have the opportunity to compare health plans using information from the Quality Reporting System. Although it is currently undergoing development, there is considerable debate as to what measures consumers would find most useful when comparing and selecting health plans. AIR is evaluating these measures to see how well they meet consumers' needs.
Project

Addressing Unnecessary Antibiotic Use in Nursing Homes

High rates of antibiotic use have been linked to the growth of healthcare associated infections as well as multi-drug resistant organisms—both of which can be life threatening to elderly patients. Along with a team of experts in nursing home care and antibiotic stewardship, AIR developed a guide that will provide nursing homes with a set of easy to use tools to implement antimicrobial stewardship practices.
Project

Aligning Cancer Care with Patient Values

Providers seek to incorporate patient perspectives into the design of care, but what is it that patients value in their care and can this be reliably measured? The Consumer Cancer Care Value Index, developed with funding from the National Patient Advocate Foundation, uses an innovative method to assess the alignment between what patients want in their cancer care and what they get.
Project

Qualified Health Plan Enrollee Survey

Patients' experiences of their own health care are essential indicators in improving quality and reducing costs. To capture valid and reliable measures of patient experience, AIR designed and conducted a study to design the consumer experience survey used by the Centers for Medicare and Medicaid Services (CMS) to assess and report on the performance of the Health Insurance Marketplaces and qualified health plans (QHPs) authorized by the Affordable Care Act.
Project

Care Coordination Measure Development

Care coordination involves deliberately organizing patient care activities and sharing information among all of the participants concerned with a patient's care to achieve safer and more effective care. For the Agency for Healthcare Research and Quality, AIR developed, tested, and validated the Care Coordination Quality Measure for Primary Care (CCQM-PC), a survey-based assessment of the quality of care coordination for adults in primary care settings.
23 Nov 2012
Report

Giving Voice to the Vulnerable: The Development of a CAHPS Nursing Home Survey Measuring Family Member Experiences

This survey was developed to measure family member experiences of nursing home care, the results of which will contribute to the understanding of quality of care in nursing homes. Unlike other CAHPS surveys, the CAHPS nursing home family member survey was developed to solicit information from respondents who do not directly receive care.
Project

CAHPS® Cancer Care Survey

The Cancer Care Survey is the first CAHPS survey designed for a specific illness. Created by AIR and the Mayo Clinic, the survey assesses the experiences of adults receiving cancer treatment in outpatient and inpatient settings, such as independent community oncology practices, cancer centers at community hospitals, and cancer centers at academic medical centers, including those designated as comprehensive cancer centers by the National Cancer Institute.
Project

Veterans’ Health Administration Survey of Healthcare Experiences of Patients

AIR assisted the Veterans Health Administration's Office of Quality Performance when they changed the content of their Survey of Healthcare Experiences of Patients to surveys modeled on the CAHPS Inpatient and Clinician-Group surveys.

Project

Patient-Reported Outcomes Measurement Information System (PROMIS) Network Center

The Patient-Reported Outcomes Measurement Information System (PROMIS) is an NIH-funded initiative to develop and validate patient reported outcomes (PROs) for clinical research and practice. As the initial PROMIS network center, AIR has been at the forefront of developing and implementing PROs to inform research and clinical care.
Project

Creation of a Cross-Specialty Surgical Version of the CAHPS Survey

AIR developed a survey to assess the quality of surgical care from the perspective of patients for the American College of Surgeons.

Project

Consumer Assessment of Healthcare Providers and Systems (CAHPS) II

AIR worked with Yale University and RAND to develop tools to assess the performance of health plans and healthcare providers from the perspectives of beneficiaries and patients for the Agency for Healthcare Research and Quality's Consumer Assessment of Health Plans Study II.

Project

TRICARE Dental CAHPS Design, Implementation and Reporting

AIR developed and pilot tested a consumer assessment survey instrument for adults to provide information about the quality of TRICARE dental benefits as reported by enrollees in the TRICARE Dental Program (TDP) and the TRICARE Retiree Dental Program (TRDP).

15 Oct 2003
Report

Team Training in Health Care: A Review of Team Training and a Look Toward The Future

During the last few years, the medical field has developed several medical-team training (MTT) programs, some implemented in the military and some developed for commercial medicine. This paper reviews the evidence-base for two categories of MTT, simulator-based programs and classroom-based programs.