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Page 159
APPENDIX A
Workshop: Envisioning a National Quality Report on Health Care
PURPOSE AND STRUCTURE OF THE WORKSHOP
The general purpose of the workshop was to provide the Institute of Medicine Committee on the National Quality Report on Health Care Delivery with practical, state-of-the-art information on the definition and reporting of national indicators of health care quality.
The workshop involved more than 40 participants and was open to the public. The topics were organized in three parts: (1) Lessons to be Learned from Other Experiences; (2) Measuring the Dimensions of Health Care Quality; and, (3) Technical, Data, and Policy Issues.
Presenters were asked to focus on the practical or applied, rather than the theoretical, aspects of their subject. They were also asked to give their opinion regarding the proposed framework for the National Health Care Quality Report as it referred to the subject they are addressing. Those presenting on specific quality measures were asked to present evidence on why the measures should be included in the Quality Report and to comment on available data sources or data needs for implementing the quality measures proposed.
ISSUES ADDRESSED AT THE WORKSHOP
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The feasibility of measuring patient centeredness, safety, effectiveness, and efficiency as dimensions of quality of care.
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The availability and appropriateness of public and private data sources for national indicators of quality of care.
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Page 159
APPENDIX A
Workshop: Envisioning a National Quality Report on Health Care
PURPOSE AND STRUCTURE OF THE WORKSHOP
The general purpose of the workshop was to provide the Institute of Medicine Committee on the National Quality Report on Health Care Delivery with practical, state-of-the-art information on the definition and reporting of national indicators of health care quality.
The workshop involved more than 40 participants and was open to the public. The topics were organized in three parts: (1) Lessons to be Learned from Other Experiences; (2) Measuring the Dimensions of Health Care Quality; and, (3) Technical, Data, and Policy Issues.
Presenters were asked to focus on the practical or applied, rather than the theoretical, aspects of their subject. They were also asked to give their opinion regarding the proposed framework for the National Health Care Quality Report as it referred to the subject they are addressing. Those presenting on specific quality measures were asked to present evidence on why the measures should be included in the Quality Report and to comment on available data sources or data needs for implementing the quality measures proposed.
ISSUES ADDRESSED AT THE WORKSHOP
The feasibility of measuring patient centeredness, safety, effectiveness, and efficiency as dimensions of quality of care.
The availability and appropriateness of public and private data sources for national indicators of quality of care.
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The feasibility of translating experiences from other sectors and countries to measure quality of health care in the United States.
The need for specific measures of quality for particular populations and tracking disparities in health care quality.
WORKSHOP AGENDA
May 22–23, 2000
Holiday Inn Georgetown—Mirage I Conference Room
2101 Wisconsin Avenue, N.W., Washington, D.C.
Monday, May 22, 2000
9:00 a.m.–9:05 a.m.
Welcome
William L. Roper, M.D., M.P.H.
Chair, IOM Committee on the National Quality
Report on Health Care Delivery
9:05 a.m.–9:15 a.m.
Introduction to the Workshop
Mark Smith, M.D., M.B.A.
Member, IOM Committee
SESSION 1: Quality Indicators in Other Sectors and Other Countries: Issues of Measurement, Presentation, Process, and Accountability
9:15 a.m.–9:30 a.m.
Measuring Consumer Satisfaction with Quality Across Industries—The American Customer Satisfaction Index
Claes Fornell, Ph.D.
University of Michigan School of Business Administration
9:30 a.m.–9:45 a.m.
Indicators of Educational Quality—The National Education Report Card (NAEP)
Peggy Carr, Ph.D.
National Center for Education Statistics
9:45 a.m.–10:00 a.m.
International Experiences in the Definition of National Indicators of Health Care Quality
R. Heather Palmer, M.B., B.Ch., S.M.
Harvard School of Public Health
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10:00 a.m.–10:30 a.m.
Discussion: Lessons for the Designers of the National Quality Report on Health Care
Moderator: Michael Millenson
William M. Mercer, Inc.
10:30 a.m.–10:45 a.m.
Break
SESSION 2: Measuring Health Care Safety for the National Health Care Quality Report
10:45 a.m.–11:00 a.m.
Update on Federal Initiatives on Error Measures and Databases
Nancy Foster, Ph.D.
Gregg Meyer, M.D., M.Sc.
Agency for Healthcare Research and Quality
11:00 a.m.–11:15 a.m.
Assessing and Reducing Errors in Health Care: The Purchaser Perspective
Suzanne Delbanco, Ph.D.
Leapfrog Group
11:15 a.m.–11:30 a.m.
Using Information Technology to Ensure and Assess Safety in Health Care
David Bates, M.D., M.Sc.
Harvard Medical School
SESSION 3: Approaches to Measuring the Efficiency of Health Care for the National Health Care Quality Report
11:30 a.m.–11:45 a.m.
Efficiency, Productivity in Medical Care, and Medical Cost Increases
Jack Triplett, Ph.D.
The Brookings Institution
11:45 a.m.–12:15 p.m.
Potential Measures of Efficiency of Health Care
Mark McClellan, M.D., Ph.D.
Stanford University
Discussant: José Escarce, M.D., Ph.D.
IOM Committee
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12:15 p.m.–12:45 p.m.
Discussion: Measuring Safety and Efficiency for the National Quality Report
Moderator: John Ware, Jr., Ph.D.
QualityMetric Inc.
12:45 p.m.–1:45 p.m.
Lunch
SESSION 4: Measuring Effectiveness and Appropriateness of Care for the National Health Care Quality Report
1:45 p.m.–2:00 p.m.
Measuring the Appropriateness of Nursing Care
Ora Strickland, Ph.D., R.N., F.A.A.N.
Emory University School of Nursing
2:00 p.m.–2:15 p.m.
Considerations on the Use of Health Outcomes as Measures of Effectiveness
John Ware, Jr., Ph.D.
QualityMetric Inc.
2:15 p.m.–2:45 p.m.
Potential Measures of Effectiveness and Appropriateness of Health Care for the National Health Care Quality Report
Elizabeth McGlynn, Ph.D.
Robert Brook, M.D., Sc.D.
RAND
Discussant: Sheldon Greenfield, IOM Committee
SESSION 5: Measuring Patient Centeredness for the National Health Care Quality Report
2:45 p.m.–3:00 p.m.
Measuring the Patient's Role in Collaborative Chronic Disease Care and Its Link to Quality of Care and Outcomes
Jessie Gruman, Ph.D.
Center for the Advancement of Health
3:00 p.m.–3:15 p.m.
Measuring the Quality of Interpersonal Care and Patient Involvement in Care
Sherrie Kaplan, Ph.D., M.P.H.
Primary Care Outcomes Research Institute, New England Medical Center
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3:15 p.m.–3:30 p.m.
What Lies Ahead? Quality Measurement and the Future Role of the Consumer in Care
Michael Millenson
William M. Mercer, Inc.
3:30 p.m.–4:00 p.m.
Developing Potential Measures of Patient Centeredness for the National Health Care Quality Report
Christina Bethell, Ph.D., M.B.A., M.P.H.
Foundation for Accountability
Discussant: Judith Hibbard, Dr.P.H., IOM Committee
4:00 p.m.–4:15 p.m.
Break
SESSION 6: General Discussion on Measures for the National Health Care Quality Report
4:15 p.m.–5:30 p.m.
Discussion
Moderator: Arnold Epstein, M.D., M.A.
IOM Committee
5:30 p.m.
Adjourn
Tuesday, May 23, 2000
SESSION 7: Issues to Be Considered in Selecting and Defining Measures for the National Health Care Quality Report
9:00 a.m.–9:15 a.m.
Defining Indicators and Indices to Track the U.S. Health Care System
Robert Rubin, M.D.
The Lewin Group
9:15 a.m.–9:30 a.m.
Quality of Care Assessments: New Paradigms
Barbara Starfield, M.D., M.P.H.
Johns Hopkins University
9:30 a.m.–9:45 a.m.
Variability as a Measure of Quality: The Influence of Patient Preferences and Provider Practice
John Wennberg, M.D., M.P.H.
Dartmouth Medical School
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9:45 a.m.–10:00 a.m.
Monitoring Racial, Ethnic, and Socioeconomic Disparities in Health Care: Conceptual Issues and Practical Considerations
David Williams, Ph.D.
University of Michigan
SESSION 8: Available and Needed Data for the National Health Care Quality Report
10:00 a.m.–10:15 a.m.
Public Sources of Data and Possible Indicators for the National Health Care Quality Report
Irma Arispe, Ph.D.
National Center for Health Statistics
10:15 a.m.–10:45 a.m.
Potential Quality Indicators Using Private Data Sources and Future Data Needs for the National Health Care Quality Report
Marsha Gold, Sc.D.
Mathematica Policy Research
Discussant: William Stead, IOM Committee
SESSION 9: Technical and Data-Related Barriers to Producing a National Health Care Quality Report
10:45 a.m.–11:30 a.m.
Discussion
Moderator: R. Heather Palmer, M.B., B.Ch., S.M.
Harvard School of Public Health
11:30 a.m.–11:45 a.m.
Break
SESSION 10: Roundtable—What Do Policy Makers Want from the National Health Care Quality Report?
Moderator: Robert Rubin, M.D., The Lewin Group
11:45 a.m.–12:30 p.m.
Congress
Cybele Bjorklund, M.P.H.
Senate Committee on Health, Education, Labor and
Pensions
Jason Lee, Ph.D.
House Committee on Commerce
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The States
Lee Partridge
American Public Human Services Association
John Colmers, M.P.H.
Maryland Health Care Commission
Other Policy Makers: Insurers
Donald Young, M.D.
Health Insurance Association of America
12:30 p.m.–1:00 p.m.
Discussion: How to Produce a Report Useful to
Policy Makers and Understandable to the Public
1:00 p.m.–1:15 p.m.
Closing Comments
Mark Smith, M.D., M.B.A., IOM Committee
1:15 p.m.
Adjourn
WORKSHOP SPEAKERS
IRMA E. ARISPE, Associate Director for Science, Division of Health Care Statistics, National Center for Health Care Statistics, Hyattsville, Maryland
DAVID W. BATES, Chief, Division of General Medicine, Brigham and Women's Hospital, Boston, Massachusetts
CHRISTINA BETHELL, Senior Vice President, Research and Policy, Foundation for Accountability (FACCT), Portland, Oregon
CYBELLE BJORKLUND, Deputy Staff Director, Senate Committee on Health, Education, Labor and Pensions, Washington, D.C.
ROBERT H. BROOK, Vice President and Director, RAND Health and Corporate Fellow, The RAND Corporation, Santa Monica, California
PEGGY G. CARR, Associate Commissioner, Assessment Division, National Center for Education Statistics, Washington, D.C.
SUZANNE F. DELBANCO, Executive Director, Leapfrog Group, Washington, D.C.
CLAES G. FORNELL, Donald C. Cook Professor of Business Administration and Director, National Quality Research Center, University of Michigan School of Business Administration, Ann Arbor, Michigan
NANCY FOSTER, Agency for Healthcare Research and Quality, Rockville, Maryland
MARSHA GOLD, Senior Fellow, Mathematica Policy Research, Inc., Washington, D.C.
JESSIE GRUMAN, Executive Director, Center for the Advancement of Health, Washington, D.C.
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SHERRIE H. KAPLAN, Co-director, Primary Care Outcomes Research Institute, Tufts University School of Medicine, New England Medical Center, Boston, Massachusetts
JASON LEE, Health Policy Counsel, U.S. House of Representatives, Committee on Commerce, Washington, D.C.
MARK B. McCLELLAN, Assistant Professor, Department of Economics, Stanford University, Stanford, California
ELIZABETH A. McGLYNN, Senior Researcher, The RAND Corporation, Santa Monica, California
GREGG MEYER, Director, Center for Quality Measurement and Improvement, Agency for Healthcare Research and Quality, Rockville, Maryland
MICHAEL L. MILLENSON, Principal, William M. Mercer, Inc., Chicago, Illinois
R. HEATHER PALMER, Director, Center for Quality of Care Research and Education, Harvard School of Public Health, Boston, Massachusetts
LEE PARTRIDGE, American Public Human Services Association, Washington, D.C.
ROBERT J. RUBIN, President, The Lewin Group, Falls Church, Virginia
BARBARA STARFIELD, University Distinguished Professor, The Johns Hopkins University, Baltimore, Maryland
ORA STRICKLAND, Professor, Neil Hodgson Woodruff School of Nursing, and Director, Research on Special Populations of Veterans, Atlanta VA Medical Center, Atlanta, Georgia
JACK E. TRIPLETT, Visiting Fellow, Brookings Institution, Washington, D.C.
JOHN E. WARE, JR., President and Chief Scientific Officer, QualityMetric, Inc., Lincoln, Rhode Island
JOHN E. WENNBERG, Director, Center for Evaluative Clinical Sciences, Dartmouth Medical School, Hanover, New Hampshire
DAVID R. WILLIAMS, Senior Research Scientist, Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan
DONALD YOUNG, Chief Operating Officer and Medical Director, Health Insurance Association of America, Washington, D.C.
Representative terms from entire chapter:
care quality
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