TABLE 1

Four Measurement Domains of STEM

DomainExample of Potential MeasuresDetails and Specifications for Examples
Health outcomes (measuring the individual or population level related to physiology, mental health, and quality of life; these measures may come from diagnostic tests and encounter records or from patient-reported outcomes)MortalityNo. deaths from COVID-19 divided by the No. patients with positive test results for COVID-19
BMI and percentilePatient’s BMI over time, >95% (obesity)
Type 1 diabetes blood glucose management: monitoring and treatment (HbA1c target [<7.5%], with individualized considerations)Percentage of children and adolescents with type 1 diabetes whose most recent HbA1c level is <7.5% (American Diabetes Association guidelines)
Health delivery (quality and cost) (measuring timely access, effectiveness of care, costs, safety, and equity)Access: children and young adults aged 12 mo to 19 y who had a visit with a primary care practitionerAn HEDIS measure: https://www.ncqa.org/hedis/measures/children-and-adolescents-access-to-primary-care-practitioners-cap/
Access: follow-up care for children aged 6–12 y who were prescribed an ADHD medicationAn HEDIS measure: https://www.ncqa.org/hedis/measures/follow-up-care-for-children-prescribed-adhd-medication/
Effectiveness: preventive care guidelinesCompliance with preventive care guidelines (ie, counseling on nutrition and physical activity for children and adolescents done through either an in-person or a telemedicine visit)
Effectiveness: vaccination rateVaccination coverage in specific pediatric age cohorts
Safety: antibiotic prescription rateRate of children aged 3 mo to 18 y who were given a diagnosis of upper respiratory infection and were not dispensed an antibiotic prescription (HEDIS): https://www.ncqa.org/hedis/measures/appropriate-treatment-for-children-with-upper-respiratory-infection/
Safety of telehealth visits: percentage of unanticipated ED visitsNo. completed telehealth visits with unanticipated, subsequent ED visits divided by the No. completed telehealth visits
Patient cost: average miles saved from not traveling to the provider’s officeMiles from home to clinic or hospital setting: tracking distance allows for calculations of time saved and dollars saved
Equity: percentage of clinical encounters delivered via telehealth in communities with low and high incomesNo. telehealth visits divided by the No. clinic encounters (telehealth and in-person visits) among patients from different income levels
Individual experience (measuring the quality and characteristics of the telehealth encounter itself and its impact on the individual patient or provider in terms of workload burden, satisfaction, and issues experienced with technology and logistics)Net Promotor ScoreA common customer-experience metric used to measure customer loyalty to a company that provides a specific service for that customer, often an estimator of customer satisfaction
Patient centeredness: responses to survey questions about patient centerednessHow much did the provider include you in the decision-making? How much did you feel that the provider heard all your concerns?
Staff wellness and burnoutExamples tools: Maslach Burnout Inventory, Oldenburg Burnout Inventory, Physician Work Life Study single-item measure, Stanford Professional Fulfillment Index, and Well-Being Index
Patient burden reduction: saved workdays or reduced No. missed school daysNo. lost workdays or missed school days due to health appointments
UsabilityDid you have difficulties getting to your appointment (either traveling to the clinic or using the telehealth system)? Did you have any technical difficulties?
Program implementation and KPIs (measuring program performance, implementation process, and benchmarks with peer programs; measuring how the system adapted human resources, processes, and tools)System changesNo. and type of changes to the system to accommodate the program (eg, hiring remote diabetes educators, purchasing devices, investing in technology support services, and creating telehealth platforms)
KPIsNo. telehealth visits completed within timeliness of care targets set by the program
  • ADHD, attention-deficit/hyperactivity disorder; ED, emergency department; HEDIS, Healthcare Effectiveness Data and Information Set.