Index
A
Acceleration Translation of Research into Practice, 155
Access to care
accountability for, 29
current measurement of, 3, 117
insurance coverage and, 23, 117
NQCB rationale, 67
in rural areas, 24
starter set of performance measures, 211–212
Accountability
for access to care, 29
goal of NQCB, 7
goals for performance measurement system, 2, 13, 55–56, 98, 167
quality oversight, 25
shared accountability, 84, 88, 97–98, 122, 123, 168–169
in transitional care, 269
Accreditation
current performance measurement for, 44, 45–46
quality improvement efforts, 25, 41
for transitional care, 263, 267
Accreditation Council for Graduate Medical Education, 25
Acute care performance measures, 11, 106–107, 206–207
Acute myocardial infarction
mortality measurement, 120
starter set performance measures, 109, 116
Administrative data
case studies of data collection, 152, 156, 158
components of performance measurement system, 42–43
current set, 31–32
limitations, 27, 191–192, 227–228, 234
opportunities for improvement, 198–199, 232–233
structural measures of quality, 186
Adverse selection, 77, 124, 126
Advisory Council for Health Care Quality, 47
After-Death Bereaved Family Interview, 302, 310–311, 311
Agency for Healthcare Research and Quality, 43–44
capacity for management of national system, 65–66
clinical priority areas for quality improvement, 174
in community-level performance measurement, 97
performance measurement program, 24–25, 45, 134–135, 155, 185, 230, 262
Preventive Quality Indicators, 94
recommendations for research, 14–15, 114, 126
Aging, population
care assessment (ACOVE), 119, 262, 274, 302–303, 313
cost of care and, 20
Alzheimer’s disease, 89
Ambulatory care
current performance measurement programs, 50, 178–179
information technology implementation, 26
patient perspective, 105–106
starter set of performance measures, 11, 103–106, 204–206
Ambulatory care Quality Alliance, 50, 102, 103, 136–137
American Academy of Pediatrics, 267
American Board of Internal Medicine, 51
American Board of Medical Specialties, 25
American College of Cardiology, 190
American Diabetes Association, 51
American Heart Association/American Stroke Association, 51
American Medical Association, 49, 50, 179
Anderson/Helms Referral Data Inventory, 262
Antibiotic therapy, 105
Assessing Care of Vulnerable Elders, 119, 262, 274, 302–303, 313
Audits of performance measurement system, 3, 77
data verification, 43
Australia, 52–53
B
Bridges to Excellence, 25, 51, 230, 232, 265
Brown Atlas of Dying, 289–302
Brown University, 304
C
California Healthcare Foundation, 119, 262, 265
Canada, 22
Cancer treatment, 21, 103–104, 116–117, 303–304, 305–306
Cardiovascular disease, 154, 155, 162
Care Management Workgroup, 266–267
Care Transitions. See Transitions, care in
Care Transitions Measure, 257, 272–273
Case management, 26
Case-mix adjustment in performance measurement, 99–100, 121, 192, 258, 261, 269
Centers for Disease Control and Prevention, 74, 97
Centers for Medicare and Medicaid Services
capacity to manage national performance measurement system, 65–66
clinical priority areas for quality improvement, 174
composite measures, 93
current performance measurement programs, 40, 46, 50, 51, 64, 138–139, 262
performance incentive program, 29
performance measurement program, 41, 43–44, 185
public reporting system, 27, 28
transitional care assessment, 252, 263–264
Chart review abstraction, 50, 107, 152–153, 269
limitations, 191
opportunities for improvement, 198–199, 232–233
Chronic illness
clinical priority areas for quality improvement, 173–174, 175
complication rates, 13
coordination of care, 29
definition, 129
performance measurement, 103, 104
process measures, 186–188
quality of care assessment framework, 173
shortcomings of current performance measures, 89
shortcomings of health plan designs, 28, 29
trends, 104
See also Long-term care;
specific disease
Chronic obstructive pulmonary disease, 89
Clinicians and providers
assistance for performance measurement implementation, 12, 102
case studies of performance measurement implementation, 150–164
current performance recognition programs, 51
data collection challenges, 49, 120
data collection requirements of NQCB, 79–80
financial incentives for performance measurement, 148
individual-level performance measurement, 195–196
insurance program disincentives to quality care, 28–30
measures of efficiency, 226–227
performance data for consumers, 27–28
performance measurement methodology, 122–123
physician support for performance measurement, 145–148
possible negative effects of NQCB implementation, 77, 126
quality oversight, 25
reduced regulatory burden for high performance, 31
strategies for implementing performance measurement, 144–149
sustaining quality improvement, 148–149
in underserved areas, 81
See also Payment incentives
Cognitive functioning assessment, 294–295
Colorado Foundation for Medical Care, 266
Colorectal cancer, 116–117
Community-level performance measurement, 97
Community Medicine Associates, 150, 151, 161–163
Competition, 27
Composite measures
case study, 152
definition, 91–92
implementation, 93
obstacles to development of, 92–93
rationale, 92
scoring methodology, 93–94, 123
Comprehensive measurement
components, 115–116
efficiency measurement, 116–117
equity measurement, 117–118
goals for performance measurement system, 84, 89, 95
patient-centered measures in, 118–119
research, 115–119
Confidentiality, 22, 77, 80–81, 100–102
Constipation assessment, 294–295
Consumer advocacy to improve quality of care, 27
Consumer Assessment of Health Plans Survey (CAHPS), 45
Consumer Assessment of Healthcare Providers and Systems (CAHPS), 45, 105–106, 107, 118–119
Consumer choice
current reporting system and, 27–28, 46
decision quality, 119
goals of performance measurement system, 2, 31, 43, 167
public reporting formats to enhance, 123–124
See also Access to care
Consumer perspective
ambulatory care performance measurement, 105–106
current efforts to measure, 41, 45, 118
data collection needs, 42
longitudinal experiences of care, 119
medical decision-making, 119
palliative care assessment, 300–301
perceptions of current health system performance, 22, 24
in performance measurement, 90, 118, 168
performance report design, 123–124
quality measurement framework, 173
starter set of performance measures, 213–214
transitional care experiences, 262–263
See also Patient-centered care
Consumer-Purchaser Disclosure Project, 25
Continuity of care
measures of, 90
palliative care assessment, 300–301
See also Transitions, care in
Contract authority of NQCB, 8, 71, 114
Cooperative Cardiovascular Project, 195
Coordination of care, 28, 29, 75, 92, 108–109, 119, 251.
See also Transitions, care in
Coronary artery disease, 50
care delivery, 104
mortality measurement, 120
performance measurement case studies, 154, 155, 162
starter set of performance measures, 204–205
See also Acute myocardial infarction
Cost of care
birth defects, 105
in performance measurement, 91
public perception, 24
sources of increases in, 20
transitional care, 252
uninsurance rates and, 23
See also Efficiency of care
Costs of performance data collection, 150, 199
Crossing the Quality Chasm: A New Health System for the 21st Century, 1, 3, 17, 53, 84, 172, 173–174
D
Data collection
auditing of performance measurement system, 3, 10, 43, 77
challenges for small firms, 149–150
components of performance measurement, 42–43, 198–199
consumer surveys, 45
on efficiency of care, 227, 232–235
to improve performance measurement, 198–199
national vs. local, 100–102
NQCB requirements, 74, 76, 79–80
obstacles to starter set implementation, 100–102
patient record review costs, 152–154
on physician practices, challenges in, 49, 120
possible negative effects of NQCB implementation, 77, 125–126
privacy and confidentiality, 80–81
recommendations for NQCB, 7, 10–12, 68, 69, 76, 77, 102
sample size, 122–123, 188–189, 191
scope of, in health care system, 27
See also Electronic health records;
Information technology;
Performance measures;
Chart review abstraction
Dementia, 89
Department of Health and Human Services, 8, 45, 71
Department of Veterans Affairs, 179, 190
Depression, 50
service delivery, 104
starter set of performance measures, 206
Diabetes, 149–150
performance measurement case studies, 154, 155, 156, 157, 160, 162
starter set of performance measures, 205
Diabetes Physician Recognition Program, 51
Dialysis centers, 28
Disease-specific mortality measures, 120, 121
Donabedian model for quality of care assessment, 170–172
Dyspnea assessment, 294–295
E
Effectiveness of care
current health care system, 21–22
definition, 130
starter set of performance measures, 208–211
Efficiency of care
case study of physician performance profiling system, 158–159
cost calculations in measuring, 228–229
current measurement efforts, 41, 229–230
data standardization, 231
episodic, 117
goals, 1, 31, 172, 224–225, 237–238
longitudinal, 116–117
measurement by medical specialty, 235
over time, 13
performance measurement, 103, 105, 225–230
productive efficiency, 223
quality dimensions of measurement, 231–232
research needs, 116–117, 230–238
resource allocation model, 223
resource attribution in measurement of, 235–236
risk adjustment and, 227–228, 237
starter set of performance measures, 11, 108–109
technical efficiency, 223
Elderly, 104
Electronic health records
barriers to implementation, 149
current use patterns, 25–26
definition, 129
implementation case studies, 155, 156–157, 163–164
NQCB implementation, 10–12, 79–80
role in performance measurement, 167–168
Electronic prescribing, 25, 106–107
Emotional functioning assessment, 294–295
End-of-life/palliative care, 173
bereavement assessment, 312
care planning assessment, 296–299, 307–309
caregiver concerns, 311
challenges in performance measurement, 287, 313–317
current performance measurement, 173, 287, 288–304
domains of measurement, 288
performance measurement rationale, 287–288
quality improvement projects, 304–307
quality of care, 22
recommendations for measurement, 307–313
site-of-death issues, 313–315, 316
survival time measurement, 317
End-stage renal disease
mortality measurement, 120
NHQR performance measures, 221
starter set of performance measures, 11, 108, 221
Epidemiological research, 74
Episodic efficiency, 117
Equitable care
current measurement efforts, 3, 41
data collection needs to assess, 13
definition, 131
NQCB rationale, 67
performance measurement goals, 96
regional variation, 24
research needs, 117–118
role of NQCB, 7–8
shortcomings of current health care system, 2, 23
Evidence-based practice
NQCB design principles, 166–167
organizational characteristics and, 26
recommendations for NQCB, 73–74
F
Family care-giving, 253–254
Federal Employees Health Benefits Program, 9, 72
Fee for service
definition, 129
longitudinal measurement and, 89
Food and Drug Administration, 174
Forum for Health Care Quality Measurement and Reporting, 47
Foundation for Accountability, 84, 93, 173, 174
Funding
assistance to providers for starter set implementation, 12, 102
to develop national performance measurement system, 6, 53–54
financial incentives for performance measurement, 148
National Quality Forum, 49
G
Goals for health system
efficiency measurement and, 237–238
performance measure selection and, 192–195
performance measurement linkage, 3, 6
progress to date, 1–2
recommendations for, 10
selective referral, 177, 194–195
Government Accountability Office, 10
Grantmakers in Health, 14, 126
GreenField Health (Oregon), 149, 150, 159–160
H
Health Insurance Portability and Accountability Act, 80
Health maintenance organizations, 44
Health Plan Employer Data and Information Set, 100
ambulatory care measures, 178–179
limitations, 27–28
record review costs, 152
starter set of performance measures, 107, 208–219
Health plans
consumer decision-making, 27–28
current performance measurement, 27–28, 196–197
obstacles to high-quality care in design of, 28–30
provider performance incentives, 28–29, 41
stability assessment, 214–215
starter set performance measures, 11, 107–108, 214–215, 218–219
See also Insurance
Health Resources and Services Administration, 8, 71–72
HealthPartners, Inc., 93, 152–154
Healthy People 2010, 94
starter set of performance measures, 205
Heart/Stroke Physician Recognition Program, 51
Hip fracture treatment, 116–117
HIV screening, 105
Home health care
current performance assessment programs, 46
public reporting system, 28, 220
starter set of performance measures, 107–108, 220
Home Health Compare, 46
Hospital Quality Alliance, 138–139
Hospital Standardized Mortality Rate model, 121–122
Hospitals
access, 117
acute care performance measurement, 106–107
current performance measurement programs, 40, 45–46, 185, 196–197
direct outcome measurement, 190–192
efficiency measurement, 229–230
health care spending in, 106
mortality measurement, 121–122
performance incentives, 29
public reporting system, 28
structural measures of quality of care, 185–186
Hypertension, 50
I
Infant mortality, 22, 24, 104–105
Information technology
barriers to adoption, 26
insurance payment disincentives to investment in, 29
recent initiatives to improve quality of care, 24
service delivery monitoring, 31
shortcomings of current practice, 25–26
for transitional care, 256–257, 269–270, 275
See also Data collection
Initiative for Pediatric Palliative Care, 305
Innovation
NQCB and, 10, 76, 77, 81, 89, 145
system-level measurement and, 97
Institute for Clinical Systems Improvement, 152
Institute for Healthcare Improvement, 25, 229, 304
Institute of Medicine, 1, 10, 172, 173, 174
Insurance
access to care and, 23
chronic care benefits, 28
cost of care and, 20
current population coverage, 23
need for performance measurement for system improvement, 32
provider payment systems, 29–30
in rural areas, 24
shortcomings of current system, 2
See also Health plans;
Medicare;
Uninsured population
Integrated Healthcare Association, 51
Intensive care, 305
International comparisons
infant mortality, 104–105
information technology implementation, 26
palliative care, 306–307
performance measurement efforts, 52–53
quality of care, 1
J
Japan, 22
Joint Commission on Accreditation of Healthcare Organizations
budget, 73
capacity to manage national performance measurement system, 66
NQCB and, 64
performance measurement program, 43–44, 45–46, 49, 50, 140–141, 185, 230, 256
transitional care assessment, 252, 267–268
Joint replacement, 21
L
Leadership and authority
to develop and implement national performance measurement system, 6, 15, 30, 42, 53, 66, 67, 70, 89
recommendations for NQCB, 6–7, 8–9, 69, 71–72, 89
for research agenda, 114
shortcomings of current performance measurement initiatives, 3, 6
Leapfrog Group, 25, 107, 140–141, 185, 230, 232, 265
Life expectancy, 22
Local circumstances, NQCB sensitivity to, 10, 74, 75–76, 81
Long-term care
starter set of performance measures, 11, 107–108, 220
See also Chronic illness;
Time frame of measures
Longitudinal measurement, 167
of continuity and transitions, 90, 119–120
of cost of care, 91
of disease-specific mortality, 120
efficiency evaluation, 116–117
goals of national performance measurement system, 84, 167
of outcomes, 90–91, 108–109, 120
of pain control, 120
shortcomings of current system, 87–88
starter set, 108–109
M
Medicaid
consumer decision-making, 28
current performance measurement in, 44
See also Centers for Medicare and Medicaid Services
Medicare
charge of Redesigning Health Insurance Performance Measures, Payment, and Performance Improvement Project, 17–20
Conditions of Participation, 252, 269
consumer choices, 27
Medicare Advantage Plans, 27, 107
Medicare Payment Advisory Commission, 10, 73
payment incentives and, 20
Quality Improvement Organization Program, 17–20, 25, 41, 266, 275
recommendations for public reporting, 9, 72
resource consumption patterns, 253
See also Centers for Medicare and Medicaid Services
Medicare Prescription Drug, Improvement, and Modernization Act (2003), 2, 106, 174
Mortality
data collection needs, 13
disease-specific measures, 120, 121
patterns and trends, 21
performance measurement challenges, 120, 121–122
starter set performance measures, 109, 116
See also Hospital Standardized Mortality Rate
Multidisciplinary team-based care, 29
N
National Committee for Quality Assurance (NCQA)
capacity to manage national performance measurement system, 66
collaborations in performance measurement, 49, 50
functions, 73
performance measurement activities, 27–28, 40, 43–44, 51, 64, 140–141, 178, 229–230, 231, 232
transitional care assessment, 265
National Health Information Network, 24
National Healthcare Disparities Report, 118
National Healthcare Quality Report, 97
National Hospice Data Set, 302
National Institutes of Health, 21
National Medicaring Quality Improvement Collaborative, 304
National Quality Coordination Board (NQCB)
accountability, 8, 9–10, 72–73
authorities, 6–7, 8–9, 69, 70, 71–72
data collection requirements, 79–80
evidence-based decision-making in, 73–74
impact assessment, 124–126
implementation monitoring, 76, 77
obstacles to implementation, 69–70, 149–150
physician support for, 145–148
possible adverse consequences of implementation, 77–81, 125–126
privacy concerns, 80–81
recommendations for, 6–15, 68–69, 70–73, 76, 102, 114, 126
relationships with stakeholders and organizations, 8–9, 69, 70, 71–72, 76–77, 126
research functions. See Research agenda for NQCB
resources for implementation, 148
role in setting health system goals, 7, 10, 68, 89, 166–167
sensitivity to local conditions, 10, 74, 75–76, 81
See also Performance measurement, national system of
National Quality Forum (NQF), 142–143
acute care performance measurement, 106
ambulatory care performance measurement, 50, 178–179
capacity to manage national performance measurement system, 64, 66
end-of-life care assessment, 306, 317
hospital-based care assessment, 185, 229
origins and development, 47–48
quality-of-care assessment, 232, 306
shortcomings, 48–49
starter set measures, 106
Strategic Framework Board, 48
transitional care assessment, 263–264
National Surgical Quality Improvement Program, 190, 191, 197
National Technology Transfer and Advancement Act, 48
NCQA. See National Committee for Quality Assurance
North Texas Medical Group, 151, 163–164
NQCB. See National Quality Coordination Board
Nursing Home Compare, 46, 220, 307
Nursing homes
early performance assessment programs, 46
public reporting system, 28, 220
starter set of performance measures, 107–108
O
Organizational characteristics
data collection needs, 42
Donabedian model for quality of care assessment, 170–172
health care system, 27
information technology implementation, 26
NQCB, 78–79
structural measures of care, 185–186
Osteoarthritis, 50
Outcome and Assessment Information Set, 46, 107–108
Outcomes measurement
challenges in provider evaluation, 49, 120
current quality of care assessment programs, 190–192
disease-specific mortality, 120, 121
in efficiency of care measurement, 116
in end-of-life/palliative care, 313–315
hospital-specific mortality, 121–122
longitudinal measures, 89–91
pain control, 120
process measures and, 186–188, 189
standardization, 42
starter set of performance measures, 11, 108–109
structural measures, 185–186
in transitional care, 90, 119, 263
P
Pain management assessment, 49, 120, 290–293, 304, 309–310
Palliative care. See End-of-life/palliative care
Palliative Care Benchmarking, 303
Pathways to Quality Health Care reports, 2–3, 17–20
Patient-centered care
current measurement efforts, 13, 41
health care system goals, 1, 31, 172
patient-level measurement, 13, 42–43, 84, 88, 91–92, 95–96, 118–119, 201
Patient’s Bill of Rights, 48
Patients’ Evaluation of Performance in California, 262–263, 265, 271–272
Payment incentives
case study, 159
current health plan shortcomings, 28–29
current quality improvement efforts, 29, 41
goals of Redesigning Health Insurance Performance Measures, Payment, and Performance Improvement Project, 20
impact of performance measurement, 7
need for performance measures to implement, 2, 30–31
rationale, 31
strategies for health system improvement, 1, 2–3
in transitional care, 269
Pediatric palliative care, 305
Performance measurement, national system of
alternatives to, 65–68
challenges to development and implementation, 42, 53–54
data collection and analysis capabilities for, 42–43
design principles, 57, 84, 166–169
desirable attributes, 3, 54–57
as disincentive to innovation, 77
evaluation of, 14, 114, 124–126, 169
international comparison, 52–53
lessons from NQF, 49
local considerations, 10
pioneering programs, 43–46
prospects for health system without, 15, 64–65, 79
public health role, 57
quality improvement role, 56–57
rationale, 2, 3, 15, 30–32, 46–47, 63
recent collaborative efforts, 46–51
shortcomings of current initiatives to develop, 3–6, 49, 51, 53–54, 64, 68
strategies for implementing, in health care organizations, 144–149
See also National Quality Coordination Board (NQCB);
Performance measures
Performance Measurement Coordinating Council, 49
Performance measures
access to patient-level data, 42–43
approaches to improve health care, 84–86, 87–88
care across settings, 89–90, 95
case studies of implementation, 150–164
chronic care, 104
community-level, 97
composite measures, 13, 88, 91–94
comprehensive measurement, 84, 87, 88, 89, 95, 115–119, 166
condition-specific, 196
consistency in application, 3
criteria for selection, 98, 192–196
current leading sets, 84, 170, 178–179, 185, 196–197
definition, 130
development methodology, 122–123
efficiency of care, 103, 105, 116–117, 229–230
end-of-life/palliative care, 288–304, 307–313
equity of care, 117–118
evaluation of, 177–178
longitudinal, 84, 87–88, 89–91, 116–117, 119–120, 167
outcome measures, 190–192
pain control, 120
patient-centered, 13, 84, 88, 91–94, 95–96, 118–119
population-based, 13, 84, 88, 91, 94–96, 167
prenatal care, 104–105
preventive care, 103–104
procedure-specific, 196
process measures, 186–190
reliability, 19–201
research agenda, 114–122, 198–201
role of NQCB in developing, 7, 68
shared accountability, 84, 88, 97–98, 122, 168–169
shortcomings of current set, 12–13, 31–32, 41, 43, 83, 84, 86–98, 99–100, 175
standardization requirements, 42, 43
structure measures, 185–186
systems-level, 13, 91, 96–97, 121
transitional care, 261–264, 270–274
See also Performance measurement, national system of;
Starter set of performance measures
Pharmacy services
data management, 234–235
electronic prescribing, 25, 106–107
public perception of drug costs, 24
in transitional care, 234–235
Physician Consortium for Performance Improvement, 50, 142–143, 179
Physician Practice Connections, 51
Pneumonia, 106
Population-based measurement, 84, 88, 91, 94–96, 167
Population-based measures, 13
Preferred provider organizations, 107
Prenatal health
performance measurement, 50, 103, 104–105
starter set of performance measures, 206
President’s Advisory Commission on Consumer Protection and Quality in the Health Care Industry, 47
Prevention
performance measurement, 50, 103–104
population health improvement, 94
in prenatal care, 105
process measures of, 186–188
role of national performance measurement system, 57
starter set of performance measures, 204
Prime Care Family Practice, 151, 155–157
Private sector research, 21
Process of care measurement, 186–190
Providers. See Clinicians and providers
Public good, 6
Public reporting on performance
case studies, 154
current programs, 6, 27–28, 40–41
evidence of quality improvement from, 63–64
format design and testing, 14, 15, 114, 123–124
impact of performance measurement, 7
implementation of national system, 57
local considerations, 10
national performance measurement system and, 2, 3, 15, 30–31, 57
rationale, 31
recommendations for Medicare, 9, 72
strategies for health system improvement, 1
Purchasing practices
contract authority of NQCB, 8, 71, 114
recent initiatives to improve quality of care, 25
Q
Quality improvement, 2
clinical priority areas for, 173–174
collaboratives, 1
consumer advocacy for, 27
current efforts, 1–2, 24–25, 41
definition, 131
end-of-life/palliative care, 304–305
environmental barriers to, 26
government regulation for, 30
need for performance measures for, 2, 3, 15, 30–32, 56–57
obstacles to, 2
organizations, 17–20
professional education and monitoring for, 30
sustaining, after performance measurement implementation, 148–149
in transitional care, 255–261, 264–270
See also Quality of care
Quality Improvement Organizations. See Medicare, Quality Improvement Organization Program
Quality of care
analytic frameworks for assessing, 84, 170, 201
case studies of performance measurement implementation, 150–164
changes needed to improve, 17
cost of care and, 20
current physician recognition programs, 51
demographic inequities, 23
direct outcome measures, 190–192
efficiency of care measurement, 116, 231–232
health care spending and, 1–2, 22
health plan design as obstacle to, 28–30
impact of performance measurement, 7, 63
NQCB impact assessment, 124–126
oversight, 25
patient perceptions of, 22, 24
population health, 94
practice characteristics and, 26
process measures, 186–190, 260, 261, 262
public reporting effects on, 63–64
scope of measurement, 12
structural measures, 185–186, 260–261
See also Quality improvement
Quality of Care for Oncologic Conditions and HIV, 303–304
R
Race/ethnicity
current inequities in health system, 2, 23
data collection needs, 13, 118
treatment outcome disparities, 103–104, 118
treatment outcome measurement, 120
RAND Corporation, 93, 197, 262, 303–304
Redesigning Health Insurance Performance Measures, Payment, and Performance Improvement Project, 2–3, 17, 24
Regional variation
disparities in care, 118
Regulation to improve quality of care, 30
reduced regulatory burden for high-performance providers, 31
Research
efficiency of care measurement, 230–238
to improve performance measurement, 198–201
NQCB agenda. See Research agenda for NQCB
palliative care, 312–313
performance report design, 123–124
recent initiatives to improve quality of care, 24–25
Research agenda for NQCB
contracting and grantmaking authority, 114
efficiency of care, 116–117
funding, 14
goals, 7, 68, 74–75, 109, 113, 115
new measure development and implementation, 114–123
performance measurement system evaluation, 124–126
recommendations, 14–15, 114, 126
definition, 131
direct outcome measurement and, 191–192
efficiency measurement and, 227–228, 237
limitations of current system, 6, 67, 77, 99–100
research recommendations, 14, 114, 122
Robert Wood Johnson Foundation, 305
Rochester Individual Practice Association, 158–159
Rural areas, 81
S
Safety of care
current health care system, 21–22
definition, 130
recent initiatives to improve, 24–25
in transitions, 254–255
Scope of performance measurement, 12
Selective referral, 177, 194–195
Shared accountability, 84, 88, 97–98, 122, 123, 168–169
Small practice settings
challenges to quality improvement in, 17
data collection for performance comparison, 28, 49
information technology implementation, 25
obstacles to performance measurement, 49, 149–150
sustaining quality improvement, 148–149
Society for Hospital Medicine, 266
Society for Thoracic Surgeons, 190
Socioeconomic status
current inequities in health system, 2
data collection needs, 13, 118
Spending
consumer health care, 22
current research system, 21
electronic health record implementation, 155, 156–157, 163–164
in hospitals, 106
patient record review costs, 152–154, 162
physician performance profiling system, 158
in transitional care, 252–253
See also Cost of care
Standardization of data
characteristics, 42
efficiency measures, 231
rationale, 42
resistance to national program for, 69–70
Standards-setting authority of NQCB, 8–9, 71–72
local considerations, 10
Starter set of performance measures, 204–221
acute care, 11, 106–107, 206–207
ambulatory care, 11, 103–106, 204–206
development methodology, 84, 170, 174–175
efficiency of care, 11, 108–109
end-stage renal disease, 11, 108
obstacles to implementation, 84, 100–102
recommendations, 10–12, 100, 102
Strategic Framework Board, 48
Stroke, 89
Structural measures of quality of care, 185–186, 260–261
Surgery
complications, 106
direct outcome measurement, 190
Symptom Management/End-of-Life, 306
T
Technological advancement in medicine
accomplishments, 21
cost of care and, 20
Time frame of measures, 89, 90
efficiency measurement, 116, 233–234
long-term care, 11, 90, 107–108, 220
shortcomings of current system, 13, 89
Timeliness of care
definition, 130
To Err Is Human: Building a Safer Health System, 1
Tobacco cessation programs, 104, 106
Transitions, care in
accountability in, 269
barriers to quality improvement, 268–270
barriers to quality in, 250, 251–252
case-mix adjustment in performance measurement, 269
current performance measures, 261–264, 280–286
current quality improvement efforts, 264–268
data sources, 259
elements of, 251
family care-giving in, 253–254
goals, 251
health care setting considerations, 259–260
information technology in, 269–270, 275
medical information transfer in, 235, 256–257
patterns and trends, 253
performance measurement, 90, 119, 255–261
process measures of quality of care, 260, 261, 262
quality problems in, 254–255
recommendations for performance measurement, 270–274
to self-care, 253
significance of, for quality improvement, 250
strategies for improving measurement, 274–275
structural measures of quality of care, 260–261
Transplantation, organ, 21
Treatment reminders, 20, 25, 26
U
Uninsured population
access to care, 23
economic outcomes, 23
United Hospital Fund, 304
University of Colorado Health Science Center, 119
U.S. Preventive Services Task Force, 161
Utilization
end-of-life care, 314–315
starter set of performance measures, 215–218
V
Value-based purchasing, 41
Veterans Health Administration, 9, 63, 72, 304
Vulnerable populations, 131