Priority Areas for National Action Transforming Health Care Quality (2003) / Chapter Skim
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2 Criteria for Selection
2 Criteria for Selection
Pages 29-40
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From page 29... ...
research on the quality of care reveals a health care system that frequently falls short in its ability to translate knowledge into practice, and to apply new technology safely and effectively.... If the health care system cannot consistently deliver today's science \and technology, we may conclude that it is even less prepared to respond to the extraordinary scientific advances that will surely emerge in the first half of the 21St century (Institute of Medicine, 2001a:2-3~.
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From page 30... ...
General Considerations in Determining Criteria The committee considered three general issues when discussing potential selection criteria. First, to what degree could existing evidence be a guide in assessing candidate priority areas according to the criteria?
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From page 31... ...
; MEPS (Medical Expenditure Panel Survey, 2002~; Medicare Expenditure Survey (Centers for Medicare and Medicaid Services, 2002~. 2 Behavioral Risk Factor Surveillance System (Centers for Disease Control and Prevention, 2002a)
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From page 32... ...
Improvability focuses on the degree to which gaps and unwarranted variations in the delivery of evidence-based medical care could be eliminated through changes in an area, and on opportunities to achieve major improvements in the heath care system by addressing the six national aims of quality improvement def~neci in the Quality Chasm report as being most important to patients and their families: safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity (Institute of Medicine, 200 ~ a)
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From page 33... ...
Condition improvability: Best-practice treatment or standard; valid and reliable measures for understanding and eliminating variations System improvability: Opportunity to improve relative to six aims of the Quality Chasm report; efficacy and cost-effectiveness of efforts to close quality gaps; existing and emerging areas Health disparity improvability: Opportunity to narrow gaps in care and disease burden for vulnerable and disadvantaged populations Patient inclusiveness (breadth, reach, and equity) : Age, gender, race/ethnicity, socioeconomic status, geographic location Condition inclusiveness: Preventive care, acute care, chronic care, palliative care Health care system inclusiveness: Intervention directed at multiple settings and constituents: inpatient and outpatient, providers, managers/policy makers .
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From page 34... ...
Earlier IOM reports have identified prevalence, burden of illness, and cost as key criteria for technology assessment and guideline development (Institute of Medicine, 1992; Institute of Medicine, 1995~. The Medical Expenditure Panel Survey uses prevalence and cost in identifying its list of priority conditions (Cohen, 2001~.
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From page 35... ...
To examine quality of care across the range of candidate areas and begin to identify those areas with the greatest potential improvability, the committee examined data Tom the National Committee for Quality Assurance's (NCQA) State of Managed Care Report, which rates health plans that collectively cover 90 percent of Americans enrolled in health maintenance organizations (HMOs)
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From page 36... ...
However, existing studies of health care quality improvement initiatives provide very little data on the relative efficacy or cost-effectiveness of various types of system and policy change. The committee considered the existence of valid and reliable measures for assessing the processes and outcomes of care to be a major asset in efforts to guide and monitor health care system improvement.
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From page 37... ...
, or because system changes, such as creating a patient reminder system, if implemented in one area, could also improve care for other conditions. Similarly, system changes required, for instance, to integrate tobacco dependence treatment into routine care could stimulate similar improvements in other preventive services.
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From page 38... ...
2001. Enhancements to the Medical Expenditure Panel Survey to improve health care expenditure and quality measurement.
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From page 39... ...
:35-9. Medical Expenditure Panel Survey.
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