Standards for Measures Used for Public Reporting of Efficiency in Health Care A Scientific Statement From the American Heart Association Interdisciplinary Council on Quality of Care and Outcomes Research and the American College of Cardiology Foundation Harlan M. Krumholz, MD, SM, FAHA, Chair; Patricia S. Keenan, PhD, MHS; John E. Brush, Jr, MD; Vincent J. Bufalino, MD, FAHA; Michael E. Chernew, PhD; Andrew J. Epstein, PhD, MPP; Paul A. Heidenreich, MD, MS; Vivian Ho, PhD; Frederick A. Masoudi, MD, MSPH; David B. Matchar, MD, FAHA; Sharon-Lise T. Normand, PhD; John S. Rumsfeld, MD, PhD, FAHA; Jeremiah D. Schuur, MD; Sidney C. Smith, Jr, MD, FAHA; John A. Spertus, MD, MPH; Mary Norine Walsh, MD Abstract—The assessment of medical practice is evolving rapidly in the United States. An initial focus on structure and process performance measures assessing the quality of medical care is now being supplemented with efficiency measures to quantify the “value” of healthcare delivery. This statement, building on prior work that articulated standards for publicly reported outcomes measures, identifies preferred attributes for measures used to assess efficiency in the allocation of healthcare resources. The attributes identified in this document combined with the previously published standards are intended to serve as criteria for assessing the suitability of efficiency measures for public reporting. This statement identifies the following attributes to be considered for publicly reported efficiency measures: integration of the quality and cost; valid cost measurement and analysis; minimal incentive to provide poor quality care; and proper attribution of the measure. The attributes described in this statement are relevant to a wide range of efforts to profile the efficiency of various healthcare providers, including hospitals, healthcare systems, managed-care organizations, physicians, group practices, and others that deliver coordinated care. (Circulation. 2008;118:1885-1893.) Key Words: AHA Scientific Statements  outcomes  health care  health policy  quality of care T he assessment of medical practice is evolving rapidly in the United States. An initial focus on structure and process performance measures to assess the quality of med- ical care is now being supplemented with efficiency measures to quantify the value of healthcare delivery. To address the need for standards to govern these efforts, the American Heart Association convened an interdisciplinary expert writ- ing group to identify the essential attributes of measures intended for public reporting of efficiency associated with the delivery of care for patients with cardiovascular disease or stroke. These attributes provide a framework for the devel- opment and assessment of efficiency measures. The American Heart Association and the American College of Cardiology Foundation make every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest. This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on May 30, 2008, and by the American College of Cardiology Foundation Board of Trustees on June 27, 2008. The American Heart Association requests that this document be cited as follows: Krumholz HM, Keenan PS, Brush JE Jr, Bufalino VJ, Chernew ME, Epstein AJ, Heidenreich PA, Ho V, Masoudi FA, Matchar DB, Normand SLT, Rumsfeld JS, Schuur JD, Smith SC Jr, Spertus JA, Walsh MN. Standards for measures used for public reporting of efficiency in health care: a scientific statement from the American Heart Association Interdisciplinary Council on Quality of Care and Outcomes Research and the American College of Cardiology Foundation. Circulation. 2008;118:1885–1893. This article is copublished in the Journal of the American College of Cardiology. Copies: This document is available on the World Wide Web sites of the American Heart Association (my.americanheart.org) and the American College of Cardiology (www.acc.org). A copy of the document is also available at http://www.americanheart.org/presenter.jhtml?identifier=3003999 by selecting either the “topic list” link or the “chronological list” link (No. LS-1823). To purchase additional reprints, call 843-216-2533 or e-mail kelle.ramsay@ wolterskluwer.com. Expert peer review of AHA Scientific Statements is conducted at the AHA National Center. For more on AHA statements and guidelines development, visit http://www.americanheart.org/presenter.jhtml?identifier=3023366. Permissions: Multiple copies, modification, alteration, enhancement, and/or distribution of this document are not permitted without the express permission of the American Heart Association. Instructions for obtaining permission are located at http://www.americanheart.org/presenter.jhtml? identifier=4431. A link to the “Permission Request Form” appears on the right side of the page. © 2008 American Heart Association, Inc and the American College of Cardiology Foundation. Circulation is available at http://circ.ahajournals.org DOI: 10.1161/CIRCULATIONAHA.108.190500 1885 AHA/ACCF Scientific Statement by guest on September 9, 2016 http://circ.ahajournals.org/ Downloaded from