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. 2015 Mar 15;11(3):279-91.
doi: 10.5664/jcsm.4548.

Measurement of quality to improve care in sleep medicine

Timothy I Morgenthaler  1 , Amy J Aronsky  2 , Kelly A Carden  3 , Ronald D Chervin  4 , Sherene M Thomas  5 , Nathaniel F Watson  6
Affiliations

Measurement of quality to improve care in sleep medicine

Timothy I Morgenthaler et al. J Clin Sleep Med. .

Abstract

The Board of Directors of the American Academy of Sleep Medicine (AASM) commissioned a Task Force to develop quality measures as part of its strategic plan to promote high quality patient-centered care. Among many potential dimensions of quality, the AASM requested Workgroups to develop outcome and process measures to aid in evaluating the quality of care of five common sleep disorders: restless legs syndrome, insomnia, narcolepsy, obstructive sleep apnea in adults, and obstructive sleep apnea in children. This paper describes the rationale, background, general methods development, and considerations in implementation for these sleep disorder quality measures. The Workgroup papers are published in this issue under the following titles: Quality Measures for the Care of Adult Patients with Restless Legs Syndrome, Quality Measures for the Care of Patients with Insomnia, Quality Measures for the Care of Patients with Narcolepsy, Quality Measures for the Care of Adult Patients with Obstructive Sleep Apnea, and Quality Measures for the Care of Pediatric Patients with Obstructive Sleep Apnea.

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Figures

Figure 1
Figure 1. Construct of quality assessment model.
Healthcare begins with structures (physical structures, leadership, organizations, policies, governance, etc.) that support the delivery of services. The actual delivery from the system to the patient or population takes place as a series of processes to produce outcomes. Key structural elements that increase the likelihood for good outcomes are often codified in accreditation standards. Among many candidate processes, some have stronger links to desired outcomes and are amenable to measurement to determine the extent to which the delivery processes conform to best practices. Outcomes are assessed as changes in the patient or population attributable to the processes of care (disease specific or global) or as health-state specific (patient-reported outcomes).
Figure 2
Figure 2. Driver diagram for the development of quality measures.
In this example, key care processes are identified (Care Process 1–4) that contribute to the desired clinical outcome (Clinical Outcome). In addition to developing measures to determine the performance of key clinical processes (Process Measures 1–4) and a measure of Clinical Outcome (Outcome Measure), a process was used to determine the strength of association between each process (S1–S4) and the clinical outcome.
Figure 3
Figure 3. Run chart.
The run chart displays the proportion of overweight or obese patients with OSA who have a discussion regarding weight management documented in the record within the past year of care. It is often helpful to select a statistical sample of all patients seen in a given unit of time for review, in this case one month. A run chart provides visual evidence regarding the effect of various improvement interventions (displayed in the call-outs).
See this image and copyright information in PMC

References

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