Envisioning the National Health Care Quality Report (2001) / Chapter Skim
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Appendix B: Designing a Comprehensive National Report on Effectiveness of Care: Measurement, Data Collection, and Reporting Strategies
Appendix B: Designing a Comprehensive National Report on Effectiveness of Care: Measurement, Data Collection, and Reporting Strategies
Pages 167-178
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From page 167... ...
measures, which represent two conceptually distinct approaches to measuring quality nationally. Under He leading indicators approach, three to five specific measures of effectiveness would be selected across a few domains (for example, rates of mammography screening, prevalence of the use of beta-blockers, appropriateness of coronary angioplasty)
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Selecting Clinical Areas We reviewed national data sources to identify the leading causes of morbidity and mortality and the most common reasons for physician visits in He United States for different age and gender groups in the population.2 Table B.1 shows the list of 58 clinical areas included in Be QA Tools system by population group: 20 include indicators for children, 36 for adults, and 23 for the vulnerable elderly. The clinical areas, broadly defined, represent about 55 percent ' Health Care Financing Administration, Agency for Healthcare Research and Quality, California HealthCare Foundation, Pfizer, and the Robert Wood Johnson Foundation.
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that could be used to construct additional clinical outcomes indicators. In many instances, the measures included in the QA Tools system examine whether interventions have been launched in response to poor performance on such measures (for example, whether persons who fail to control their blood sugar on dietary therapy are offered oral hypoglycemic therapy)
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170 ENVISIONING THE NATIONAL HEALTH CARE QUALI7~YREPORT TABLE B.1. Clinical Areas Included in QA Tools System by Population Group Covered Vulnerable Clinical Area Children Adults Elderly Acne Adolescent preventive services Adult screening and prevention Alcohol dependence Allergic rhinitis Asthma Atrial fibrillation Attention deficit~yperactivity disorder X Benign pro static hyperplasia Breast cancer Cataracts Cerebrovascular disease Cervical cancer Cesarean delivery Chronic obstructive pulmonary disease Colorectal cancer Congestive heart failure Coronary artery disease Dementia Depression Developmental screening Diabetes mellitus Dia~Theal disease End-of-life care Falls and mobility disorders Family planning and contraception X Fever of unknown origin X Headache Hearing impairment Hip fracture Hormone replacement therapy Hospital care Human immunodeficiency virus Hyperlipidemia Hypertension Immunizations Ischemic heart disease Low-back pain Malnutrition Orthopedic conditions Osteoarthritis Osteoporosis Otitis media Pain management X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X
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Under funding from Pfizer, the set of quality indicators selected to assess the care of vulnerable elders is being pilot-tested in two managed care organizations. A separate set of indicators for evaluating nursing home quality was developed and will be tested under funding from CHCF.
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The experience with this project provides considerable insight into the use of this tool for a National Health Care Quality Report.
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If the national report seeks to answer questions about variations in quality by region, race or ethnicity, urban versus rural, type of insurance, and so on, either a very large simple random sample would have to be drawn or a stratified sampling strategy would have to be developed. If one is interested in developing state-specific estimates, equal-sized samples could be developed for each state using either a random or a stratified approach and a national estimate produced from a weighted average.
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Participants volunteer information about their health care providers and sign consents to release copies of medical records for research purposes. Because MEPS is a national probability sample, the addition of medical record data would allow national estimates of quality to be linked to information about utilization, expenditures, and insurance coverage.
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The first approach allows individuals to be counted multiple times in the summary score if they have multiple eligible encounters with the system, which means that persons with more health problems and/or more serious problems will be weighted more in the score. The second approach makes individuals equal in their contribution to the score.
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This comprehensive approach is well suited to the requirements of a national report on quality and could be implemented by augmenting an existing national database. REFERENCES Agency for Healthcare Research and Quality (AHRQ)
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2000. Evaluating the quality of cancer care: Development of cancer quality indicators for a global quality assessment tool.
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