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Six Barriers to Consumer Involvement in the Measure Development Process

• Unequal Power: An inherent power differential exists between consumers, who have fewer available resources, and professionals, who are generally employed in the health care sector. Imbalances of power can be especially acute during technical stages of quality measurement, including creating measure concepts, specifying measures, and testing measures.
• Limited Menus: In some cases, invitations to participate in the quality measurement process are made to consumers after much of the early work has been completed. This approach leaves consumers out of some of the most important decisions that are made in quality measurement work — that is, what priorities to set, rather than which measures to use.
• Critical Mass: Quality measurement discussions often occur at stakeholder committees or expert panels that tap a handful of consumer advocates who are expected to represent a broad range of consumer experiences. The inherently diffuse nature of consumer representation argues for ensuring a critical mass of consumers.
• Flat Footed: Consumer and community input is sometimes solicited but consumer organizations do not always have adequate time to respond to requests for involvement.
• Closed Doors: Some parts of the quality measurement process may not currently involve consumers. Certain communications about quality measurement efforts happen through informal channels or parts of the process that are open to consumers in one state or location may be closed to consumers in another.
• Dual Focus: When participating in the quality measurement process, it can be a challenge to keep track of both the big picture and the details.

Quality measurement is critical to helping providers, purchasers, payers, and consumers identify high-quality care and improve the quality of care. The opportunities and challenges for consumers to engage in quality measurement warrant careful examination. This report addresses concerns of consumer advocates about making quality measurement more consumer-centered. The report explores the experience of consumer advocates in engaging with quality measurement, identifies barriers to effective consumer engagement, and suggests ways to address those barriers. This report is intended for decisionmakers in quality measurement organizations and for consumer advocates.

• Chapter One

  Introduction

• Chapter Two

  Key Steps in Creating and Using Quality Measures

• Chapter Three

  Barriers to Consumer Participation and Potential Solutions

• Chapter Four

  Recommendations

• Appendix

  Discussion Questions for Representatives of Consumer Advocacy Organizations