Do prominent quality measurement surveys capture the concerns of persons with disability?

BACKGROUND: Demonstration programs nationwide aim to control costs and improve care for people dually-eligible for Medicare and Medicaid, including many persons with disability. Ensuring these initiatives maintain or improve care quality requires comprehensive evaluation of quality of care.

OBJECTIVES: To examine whether the common quality measures being used to evaluate the Massachusetts One Care duals demonstration program comprehensively address the concerns of persons with disability.

METHODS: Drawing upon existing conceptual frameworks, we developed a model of interrelationships of personal, health care, and environmental factors for achieving wellness for persons with disability. Based on this model, we specified a scheme to code individual quality measurement items and coded the items contained in 12 measures being used to assess Massachusetts One Care, which exclusively enrolls non-elderly adults with disability.

RESULTS: Across these 12 measures, we assigned 376 codes to 302 items; some items received two codes. Taken together, the 12 measures contain items addressing most factors in our conceptual model that affect health care quality for persons with disability, including long-term services and supports. Some important gaps exist. No items examine sexual or reproductive health care, peer support, housing security, disability stigmatization, and specific services obtained outside the home like adult day care. Certain key concepts are covered only by a single or several of the 12 quality measures.

CONCLUSIONS: Common quality metrics cover most - although not all-health care quality concerns of persons with disability. However, multiple different quality measures are required for this comprehensive coverage, raising questions about respondent burden.