Development of performance measures for seven chronic diseases. Health Outcomes Work Group of the Pharmaceutical Research and Manufacturers of America.

BACKGROUND: In 1994 the Washington, DC-based Pharmaceutical Research and Manufacturers of America (PhRMA) initiated a project to develop performance measures for seven chronic diseases-chronic obstructive pulmonary disease, chronic stable angina, depression, diabetes mellitus, hypercholesterolemia, hypertension, and rheumatoid arthritis-that are commonly treated with pharmaceuticals. The project was coordinated by PhRMA's Health Outcomes Work Group (HOWG), an ad hoc committee that addresses issues concerning health outcomes research.

METHODOLOGY: For each of the seven diseases, HOWG assembled a panel of clinical experts from the pharmaceutical industry to develop the quality-of-care performance measures. HOWG wanted the measures to be ones that health plans could use to improve the quality of care, that were based on reliable data that could be standardized to account for patient population differences, and that were practical to institute (not cost prohibitive). By the end of a 1 1/2-day working session, each panel had developed at least one preliminary performance measure. Following the panels' meeting, background literature searches were conducted and supporting documentation was obtained. The panels then sent the revised performance measures to appropriate professional organizations for informal review. Another round of revisions was then completed.

CHALLENGES AND NEXT STEPS: HOWG's experience in developing these measures, which contain either or both the important clinical processes and outcomes for the respective diseases, has highlighted current challenges in the performance measure arena, such as the availability, validity, and varying sources of data. The PhRMA performance measures should be subjected to further external review and pilot tests before implementation.