Envisioning the National Health Care Quality Report (2001) / Chapter Skim
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Executive Summary
Executive Summary
Pages 1-18
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There is a gap (some say a "chasm") between the health care services that should be provided based on current professional knowledge and technology and those that many patients actually receive (Institute of Medicine, 2001; Institute of Medicine and National Research Council, 1999; Schuster et al., 2001~.
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It is these and other shortcomings in quality that led the President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry to call for a national commitment to improve quality involving both the private and the public sectors and every level of the health care system (Advisory Commission on Consumer Protection and Quality in the Health Care Industry, 1998~. To help guide this process and track progress, the Advisory Commission recommended that there be an annual report to the President and Congress on the nation's progress in improving health care quality.
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The Quality Report is intended to complement another report mandated by Congress in the same legislation. This second report, which is under development, will address "disparities in health care delivery as it relates to racial and socioeconomic factors in priority populations" (Healthcare Research and Quality Act, l999:Sec.
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If health care leaders choose to develop specific goals for improvement in the health care delivery system (for example, to achieve a 50 percent reduction in adverse drug events over the next five years) , the Quality Report can be used to track progress in meeting these goals.
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The committee concluded that no single existing data source can satisfy all of the requirements of the Quality Report, but much progress can be made by drawing on a mosaic of data sources, including consumer and provider surveys, clinical or medical record data, and administrative data. Lastly, the committee identified the main audiences for the Quality Report and developed guidelines for the design and production of reports tailored to these audiences.
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As a starting point, the committee adopted the following IOM definition of health care quality: "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~. With its emphasis on "desired health outcomes," this definition incorporates consumer perspectives on quality, while clearly linking quality to making the best use of current medical knowledge and technology.
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In addition to the two dimensions of quality components and consumer health care needs, the framework incorporates equity as a crosscutting issue, and the committee recommends that information in the Quality Report be presented by population subgroups when appropriate. The committee understands that the more in-depth, causal analysis, including issues of access and insurance, will be presented in the planned disparities report, mentioned earlier (Healthcare Research and Quality Act, 1999)
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For example, the report can be used to examine whether persons with diabetes are receiving the care they need to manage or "live with their illness" or whether children are "staving healthy" by receiving indicated immunizations at the appropriate ages. The combination of components of health care quality and consumer perspectives on health care needs defines the types of measures that should be in the National Health Care Quality Report, and can be represented as a matrix (Figure 1~.
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In the future, information on costs could be combined with information on the quality of care to provide an indication of whether the country is in effect using these resources to enhance the value received from health care spending. SELECTING MEASURES FOR THE NATIONAL HEALTH CARE QUALITY REPORT AND DATA SET RECOMMENDATION 2: The Agency for Healthcare Research and Quality should apply a uniform set of criteria describing desirable attributes to assess potential individual measures and measure sets for the content areas defined by the framework.
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~ an, ~_v ·~4 ~~— O~ ~ L~111 RECOMMENDATION 3: The Agency for Healthcare Research and Quality should have an ongoing independent committee or advisory body to help assess and guide improvements over time in the National Health Care Quality Report. (See Chapter 3.)
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RECOMMENDATION 4: The Agency for Healthcare Research and Quality should set the long-term goal of using a comprehensive approach to the assessment and measurement of quality of care as a basis for the National Health Care Quality Data Set. (See Chapter 3.)
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RECOMMENDATION 5: When possible and appropriate, and to enhance robustness, facilitate detection of trends, and simplify presentation of the measures in the National Health Care Quality Report, the Agency for Healthcare Research and Quality (AHRQ) should consider combining related individual measures into summary measures of specific aspects of quality.
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Any measures for the National Health Care Quality Report and Data Set should not stifle innovation by institutionalizing specific processes or infrastructure that could soon become outdated. SELECTING SOURCES FOR THE NATIONAL HEALTH CARE QUALITY DATA SET RECOMMENDATION 7: Potential data sources for the National Health Care Quality Data Set should be assessed according to the following criteria: credibility and validity of the data, national scope and potential to provide state-level detail, availability and consistency of the data over time and across sources, timeliness of the data, ability to support population subgroup and conditionspecific analyses, and public accessibility of the data.
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However, the CAMPS component presently planned for MEPS will have to include additional questions in order to meet the data requirements for these two components of quality and related consumer perspectives on health care needs. To assess effectiveness and safety, as well as relevant health care needs, a combination of public and private data sources should be used, including MEPS, other population surveys, claims and other administrative data, medical record abstraction, and new data sources that will have to be developed.
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15 By measuring health care quality at the national and state levels, the National Health Care Quality Report would provide benchmarks to judge how well health care delivery systems are performing at the state level relative to the degree of quality achieved for the nation as a whole. The ability to examine certain quality measures across states would substantially enhance the policy relevance, visibility, and usefulness of the report.
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Finally, the format employed should be designed so that differences across regions or groups and trends are easily discernible. CONCLUSION In this report, the IOM Committee on the National Quality Report on Health Care Delivery provides the Agency for Healthcare Research and Quality with a vision of the contents and design of the National Health Care Quality Report.
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1998. The urgent need to improve health care quality: Institute of Medicine National Roundtable on Health Care Quality.
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1991. Healthy People 2000: National Health Promotion and Disease Prevention Objectives, Pub.
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