A Formal Framework For Incorporating Equity Into Health Care Quality Measurement

Quality measurement is an important tool for incentivizing improvement in the quality of health care. Most quality measurement efforts do not explicitly target health equity. Although some measurement approaches may intend to realign incentives to focus quality improvement efforts on underserved groups, the extent to which they accomplish this goal is understudied. We posit that tying incentives to approaches on the basis of stratification or disparities may have unintended consequences or limited effects. Such approaches might not reduce existing disparities because addressing one aspect of equity may be in competition with addressing others. We propose equity weighting, a new measurement framework to advance equity on multiple fronts that addresses the shortcomings of existing approaches and explicitly calibrates incentives to align with equity goals. We use colorectal cancer screening data derived from 2017 Medicare claims to illustrate how equity weighting fixes unintended consequences in other methods and how it can be adapted to policy goals.