Preface
After several decades of close attention to the cost of health care and to the uneven access to this care across the United States, we are now beginning to seriously examine health care quality. A wide range of individual studies suggests that the quality of the health care we receive is often less than optimal, if not downright poor. Yet we lack information that would allow us to systematically examine how we are doing, to determine which aspects of our health care are better or worse, and to assess whether the quality of our care is improving over time. To help fill these knowledge gaps, the Institute of Medicine (IOM) was asked by the Agency for Healthcare Research and Quality (AHRQ) to undertake a planning effort for a "national quality report on health care delivery." In the 1999 legislation that reauthorized and renamed the agency, Congress mandated that such a report be developed and published annually starting in 2003.
Specifically, the IOM and the committee appointed to conduct this study were asked to take a long-term view and to suggest how best to measure the overall quality of health care in the nation. We were to develop a format that would allow both policy makers and the general public to make year-to-year comparisons of how the health care system is doing, allowing them to determine just how much the quality of care varies or diverges from desired levels when these are specified. Furthermore, our effort is supposed to encompass the spectrum of health care settings, not just the inpatient hospital environment. Eventually, it is also supposed to allow for state- or regional-level measures, as well as measures that compare the quality of care received by various racial, ethnic, or other groups in the population.
The committee brought together expertise in health care quality measurement, health care financing and delivery, health information systems, communications, health economics, biostatistics, medicine, and public policy, as well as the perspectives of state-level health policy makers and health care purchasers. We met four times and sponsored a workshop on the state of the art in health care quality measurement and reporting that gave us the opportunity to hear from a variety of groups and experts. Through their presentations, we learned about quality measurement in other sectors, international experiences with national health care quality reports, the availability of measures to assess diverse aspects of health care quality, and other technical and policy issues related to quality measurement. The results of these efforts are the following general and specific recommendations to AHRQ on the National Health Care Quality Report. Recognizing that the Quality Report will be a dynamic document, evolving over time and that evaluation of the report and its impact should guide subsequent efforts, we sought to give broad guidance on how to undertake the vital task of assessing the quality of health care most effectively. In addition to offering a framework for thinking about health care quality, we give specific examples of the types of measures the Quality Report should include. We also provide suggestions on the criteria for making decisions about which specific measures to include or exclude and where to obtain that information. Lastly, we provide advice on how to reach the intended audiences with this valuable information.
We believe that if properly prepared and communicated, the National Health Care Quality Report can become a mainstay of our nation's effort to improve health care quality. For just as today everyone from the stockbroker on Wall Street to the person in the street follows the economic indicators, someday soon the Congress, executive branch agencies, providers, consumers, and the public at large will be tracking trends in health care quality via the National Health Care Quality Report. We eagerly look forward to that new era.
| William L. Roper | |
| Chair | |
| Arnold M. Epstein | |
| Vice-Chair |
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