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include both national- and state-level representatives. The body could be analogous to the National Committee on Vital and Health Statistics (NCVHS) or the National Quality Forum (NQF) (Kizer, 2000; National Quality Forum, 2000; Stead, 1998) and should fulfill technical, representative, and interpretive functions.
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.
A comprehensive system is one in which the majority of care for a given population is assessed using a large number of measures representing the many components of health care quality and consumer perspectives on health care needs in an integrated manner and spanning a variety of health care settings and conditions. This approach should result in a more complete and accurate picture of the state of quality in the nation than is now available. To this end, the Agency for Healthcare Research and Quality should evaluate current efforts to develop comprehensive quality measurement systems (for example, in the area of effectiveness) and examine how they may be used and expanded.
The committee agreed that a comprehensive approach to measurement is ideal for the National Health Care Quality Data Set on which the Quality Report will be based. A limited set of measures would be insufficient to capture the four components of quality and the diverse consumer perspectives on health care needs. Therefore, conceptually, the National Health Care Quality Data Set should be as comprehensive as possible, but by necessity, reporting will be selective (see
Chapter 5 for further discussion of the Quality Report).
Experience with comprehensive systems of health care quality measurement is limited. The RAND QA Tools system (McGlynn, 2000), although still under development, shows promise as a means to assess effectiveness. QA Tools could be expanded to examine limited aspects of “patient centeredness,” timeliness, and safety, but complementary data collection and reporting systems may be have to be developed and expanded in order to cover all four components of quality in a comprehensive manner.
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. AHRQ should also make available to the public information on the individual mea-