Envisioning the National Health Care Quality Report (2001) / Chapter Skim
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Introduction
Introduction
Pages 19-39
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The IOM formed the Committee on the National Quality Report on Health Care Delivery to carry out this work. As described in this chapter, the committee studied different approaches to defining and measuring quality.
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THE IOM COMMITTEE ON THE NATIONAL QUALITY REPORT ON HEALTH CARE DELIVERY In its role of advising AHRQ on the Quality Report, the committee worked to provide a vision of what should be included. As an important part of its work, the committee held four two-day meetings in 2000, during which it considered research on major issues related to its charge and formulated its recommendations.
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~. To gather additional information from a variety of perspectives, the committee held a two-day workshop, "Envisioning a National Quality Report on Health Care." Twenty-seven speakers delivered testimony on an array of topics, including the feasibility of measuring safety, effectiveness, "patient centeredness," and efficiency as system aims for quality of care; the availability and appropriateness of public and private data sources to support measures of quality of care; the feasibility of applying experiences in quality measurement and reporting from other sectors; and the need for specific measures to gauge the quality of care for particular populations and to track potential disparities in the quality of care (see Appendix A for the workshop agenda and list of speakers)
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It did this in recognition of the need to measure quality in ways that are meaningful to the consumer. RECENT INITIATIVES ON HEALTH CARE QUALITY AND QUALITY REPORTING The work of the committee has drawn from several recent initiatives on health care quality and quality measurement.
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In addition to greater public reporting on quality, the commission recommended standardized reporting by the health care industry on core sets of quality measures; the development of a framework and increased capacity for quality measurement and reporting; industry support for the development of quality measures; and the creation of a private-sector forum to oversee quality measurement requirements, specifications, and reporting (Advisory Commission on Consumer Protection and Quality in the Health Care Industry, 1998~. A review of the scientific literature on the quality of care, conducted by scholars at RAND, further substantiated the statements of both of these groups.
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OTHER NATIONAL AND INTERNATIONAL INITIATIVES ON HEALTH CARE QUALITY MEASUREMENT The Quality Report is part of a larger national and international movement to measure quality in general, and health care quality in particular, as a necessary step in determining where improvements could and should be made (Epstein, 1996; Hussey and Anderson, 2000~. While there have been many developments in this direction in the past few years, health care quality reporting and measurement have been the long-term focus of important state, national, and international initiatives.
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. FACCT uses the measures that it and other organizations have developed as the basis for defining quality reports that consumers can use to compare health plans (Foundation for Accountability, 2000b)
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was established in response to the President's Advisory Commission's call for an organization to address pressing issues in health care quality measurement and reporting (Advisory Commission on Consumer Protection and Quality in the Health Care Industry, 19984. It is a public-private partnership among national, state, and local organizations of consumers, purchasers, providers, labor unions, and others (Foster et al., 1999; Miller and Leatherman, 1999~.
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presents quality-of-care measures in separate publications for hospitals and health maintenance organizations (HMOs) overall; different reports on hospital, doctor, and plan performance in heart attack treatment and in coronary artery bypass graft (CABG)
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Despite these and other differences, the international initiatives commonly recognize the central role that quality measurement plays in efforts to improve quality and the need to develop adequate measures and data sources to make it easier to identify areas in which performance is lagging and reasons for the poor performance. Although they are more implicit, initiatives by The United Kingdom, Canada, and Australia also recognize the significance of consumer information needs, especially those that apply to acute care (Department of Health, 2000a; Health Canada, 2000; National Health Performance Committee, 2000~.
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TQM and other customer-centered approaches have called attention to the need to measure how well organizations are serving their customers and satisfying their expectations (Dean and Bowen, 1994; Deming, 1982; Drucker, 1993; Merlyn and Parkinson, 1994~. At the May 2000 workshop on envisioning a national quality report on health care delivery, the committee heard testimony regarding the American Customer Satisfaction Index (ACSI)
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The report should also be of interest to consumers, health care providers, and health care purchasers. More specifically, the Quality Report should play a vital role in badly needed quality improvement efforts by
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To better understand what the Quality Report should try to achieve, it is also important to understand how it differs from other annual reports on healthrelated topics. The legislation that mandates the Quality Report also mandates a report on disparities in health care delivery by race and socioeconomic status (Healthcare Research and Quality Act, 1999:Sec.
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One of the focus areas is "access to quality health services." Others include aspects related to the management of chronic illness that may overlap with measures included in the Quality Report. However, the subject matter of Healthy People 2010 is public health, whereas the Quality Report's is mainly personal health care services.
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The main purpose of the Quality Report should be to inform policy makers and consumers, as well as purchasers and providers, about the state and progress of health care quality in the United States. It should examine the quality of care
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The National Health Care Quality Framework presents the categories of measures needed to comprehensively assess the quality of health care in the United States. It forms the basis for the National Health Care Quality Data Set, which contains the measures and data sources used for the Quality Report.
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_ _ ~ National Health ~ ·1` Care Quality Data J \ Set / National::: Health Care Quality~: ~~: Reports ~ I: ~ ;: FIGURE 1.1 From the National Health Care Quality Framework to the National Health Care Quality Report.
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2000. Presentation to the Institute of Medicine Committee on the National Quality Report on Health Care Delivery.
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Presentation at the Institute of Medicine Workshop "Envisioning a National Quality Report on Health Care," May 22. Fornell, Claes, Michael D
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1999. The National Quality Forum: A 'me-too' or a breakthrough in quality measurement and reporting.
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2000. The Vermont Health Care Quality Report, ton-line]
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