Diabetes All-or-None Measures
The Diabetes All-or-None Measures are two separate measures, one for process (optimal testing) and one for outcomes (optimal results). Each measure contains three goals. All three goals within a measure must be reached in order to meet that measure. The numerator of each all-or-none measure is collected from the organization's total diabetes denominator.
Using the diabetes denominator optimal results includes:
- Most recent A1C test result is less than 8.0% -- And
- Most recent LDL cholesterol test result is less than 100 mg/dL -- And
- Most recent blood pressure measurement is less than 140/90 mm Hg
Why use an All-or-None method?
Disclaimer: Measures reported by WCHQ healthcare
organizations represent a specific aspect of care in relation to an
evidence-based standard, but are not clinical guidelines and do not establish
standards of care.
This method was chosen because of the benefits it provides to both the patient and the practitioner. First, this methodology more closely reflects the interests and likely desires of the patient. With the data collected in two scores (optimal testing and optimal results), patients can easily look and see how their provider group is performing on these criteria rather than trying to make sense of multiple scores on individual measures. Second, this method represents a systems perspective emphasizing the importance of optimal care through a patient's entire healthcare experience. Third, this method gives a more sensitive scale for improvement. For those organizations scoring high marks on individual measures, the All-or-None measure will give room for benchmarks and additional improvements to be made.
Nolan T, Berwick DM. All-or-none measurement raises the bar on performance. JAMA. 2006 Mar 8;295(10):1168-70.