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Appendix D: Selected Approaches to Thinking About the National Health Care Quality Report
Pages 189-211

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From page 189...
... , but the cornm~ttee recognizes that health care does not operate in a vacuum and interested researchers can examine the data presented in the Quality Report in relation to frameworks of the determinants of health such as this.
From page 190...
... The aims proposed by the commission are largely subsumed by the ones in the framework proposed by the committee (Advisory Commission on Consumer Protection and Quality in the Health Care Industry, 1998~. As discussed, many of Healthy People 2010's focus areas are included in the National Heals Care Quality Framework as suggested conditions for which to examine quality of care (U.S.
From page 191...
... , 2001. · Def nition of Quality: Adopted the IOM definition of quality as "the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge." (Institute of Medicine, 1990:21)
From page 192...
... Measures come from a variety of sources including HEDIS, FACCT measurement sets, CAMPS (Consumer Assessment of Health Plans Survey) , and public health databases.
From page 193...
... General: FACCT has designed a patient survey FACCT~ONE that addresses quality of care for people living with illness—specifically, asthma, diabetes, and coronary artery disease. It has also defined specific quality measurement sets for adult asthma, alcohol misuse, breast cancer, diabetes, major depressive disorder, health status, health risks, and consumer satisfaction.
From page 194...
... Chassin, 1991. Def Nixon of Quality: Chassin cites the IOM definition of quality of care—"the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge" (Institute of Medicine, 1990:21~.
From page 195...
... The focus of the model is not on quality but on the determinants of health defined as social environment, physical environment, genetic endowment, health care, and individual biological and behavioral responses. Outcomes included in the model distinguish disease (as defined and treated by the health care system)
From page 196...
... At the individual level, the process of medical care consists of technical and interpersonal aspects and is influenced by the amenities of the setting of care. · Model: Donabedian's classic characterization of the approach to quality assessment includes elements of the structure of the health care delivery system, the process of care, and the outcomes of care.
From page 197...
... · Audiences: Health services researchers, providers interested in quality assurance. Categories and Measures The following list is a selection of the most relevant categories and measures for the Quality Report and is adapted from a schematic classification proposed by Donabedian in 1968 (Donabedian, 1980:Appendix B)
From page 198...
... . Staff turnover te.g., turnover of primary care providers in health plans]
From page 199...
... . Model: The commission did not have a model but declared that "the purpose of the health care system must be to continuously reduce the impact and burden of illness, injury and disability, and to improve the health and functioning of the people of the United States" (Advisory Commission on Consumer Protection and Quality in the Health Care Industry, 1998:2~.
From page 200...
... Healthy People 2010 has two overarching goals "to increase quality and years of healthy life" and "to eliminate health disparities." These goals will be monitored through 467 objectives in 28 focus areas. Healthy People 2010 also includes a reduced set of leading health indicators or focus areas reflecting major public health concerns.
From page 201...
... Policies and interventions can be used to improve health by targeting factors related to individuals and their environment, including access to quality health care. Unit of Analysis: The nation (can also apply to states and smaller geographic levels)
From page 202...
... HEALTH PLAN EMPLOYER DATA AND INFORMATION SET Description . NCQA developed the Health Plan Employer Data and Information Set to assess health plan performance and continually revises it.
From page 203...
... Unit of Analysis: Health plans and the corresponding enrolled population. Categories and Measures Effectiveness of Care .
From page 204...
... Chemical dependency utilization—percentage of members receiving services · Outpatient drug utilization Informed Health Care Choices · Management ofmenopause Health Plan Descriptive Information · Board certification or residency completion . Practitioner compensation Arrangements with public health, educational, and social service organizations Total enrollment by percentage .
From page 205...
... However, the focus is on the accountability of health plans, rather than on tracking health care quality at a national level. There is incomplete reporting of measures and health plans resulting in lack of representativeness at the national level.
From page 206...
... Returning home following treatment for a fractured hip Efficiency . Day case rate .
From page 207...
... National Health Care Quality Report since the purpose is to assess the quality of care delivery at the national level. This framework includes fair access necessary for reducing health disparities and one of the two overarching goals of Healthy People 2010 (U.S.
From page 208...
... · Audiences: Policy makers, mainly in health care arena. Categories and Measures The major causes of mortality and morbidity for the United States included in this framework are infant mortality and related conditions, otitis media, asthma, accidents and injuries, suicide, acute respiratory conditions, breast cancer, back conditions, coronary artery disease, arthritis, chronic bronchitis and emphysema, colorectal cancer, lung cancer, stroke and cerebrovascular disease, diabetes, and pneumonia.
From page 209...
... SOURCE: Siu et al., 1992. REFERENCES Advisory Commission on Consumer Protection and Quality in the Health Care Industry.
From page 210...
... 1999. Leading Health Indicators for Healthy People 2010.
From page 211...
... 1992. Choosing quality of care measures based on the expected impact of improved care on health.


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