Performance Measurement Accelerating Improvement (2006) / Chapter Skim
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5 Research Agenda
5 Research Agenda
Pages 113-128
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From page 113... ...
We argue for an accelerated effort to move beyond the status quo to ensure a broader and deeper understanding of how well the health care system is performing across all six aims of the Quality Chasm report (IOM, 2001) and, most important, where the system can be improved.
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The following sections address how action on the four fronts enumerated above can advance a national performance measurement and reporting system designed to enhance the quality of health care delivery. DEVELOPMENT, IMPLEMENTATION, AND EVALUATION OF NEW MEASURES Current efforts to develop performance measures to fill some of the gaps identified in Chapter 4 are unlikely to succeed without the more coordinated and effective leadership that the NQCB can provide in prioritizing and adequately funding a targeted research agenda to address those gaps.
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From page 115... ...
fostered by measures in the above six areas. As recommended in Chapter 3, the research agenda developed by the NQCB should be linked to well-specified goals and aims of the health care delivery system.
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From page 116... ...
Longitudinal efficiency An example of measures of longitudinal efficiency for defined populations over relatively prolonged periods is 1-year mortality and resource use for acute conditions. The feasibility of collecting these data has been demonstrated for different types of care delivery systems (Tarlov et al., 1989; Ware et al., 1996)
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From page 117... ...
and care settings (rehabilitation, ambulatory care, and acute hospital)
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. Data that capture measures of health care that matter to patients can be a powerful influence on how care is delivered by providers, purchased by payers, and adhered to by patients.
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From page 119... ...
Longitudinal Measurement As suggested earlier, longitudinal measurement will help break down the boundaries created by the current silos of the health care system. Two sets of measures are needed: measures of care transitions, or how well patients' care is coordinated as they enter into and out of different health care settings, and measures of longitudinal efficiency.
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120 PERFORMANCE MEASUREMENT Outcomes of Care Patient outcomes are the ultimate indicator of the quality of care received. These important measures reflect the extent to which providers are delivering high- or low-quality care, as well as the functioning of the broader health care system.
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RESEARCH AGENDA 121 Individual-Patient-Level, Population-Based, and Systems-Level Measurement The importance of individual-patient-level and population-based measures was highlighted above. In addition, systems-level measures are needed to assess the performance of both the smaller entities constituting the overall health care delivery system (such as hospitals and health plans)
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Measurement at both the population and systems levels addresses the larger health care system and includes the societal factors that contribute to the health of the general public. The committee therefore believes that development and promulgation of measures in all of these areas foster shared accountability.
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Additionally, reports often are not tailored to the needs of special populations who may vary widely in their specific health information needs, language, and level of health literacy. The committee believes the usability of public reports of comparative health care performance data needs to be a focus of further research, as these reports currently are not produced in formats that resonate with consumers.
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For example, it should be possible to address the following key questions more fully as a result of the performance measurement activities overseen by the NQCB: · Is performance measurement contributing to a closer evaluation of care processes so that providers are capable and desirous of changing the way they organize and deliver care to achieve improved quality? · Does performance measurement assist providers in making wiser choices concerning the allocation of resources by addressing efficiency and the overuse of services that have been demonstrated to show no benefit or possibly even harm to patients?
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From page 125... ...
and influence provider behavior, the NQCB needs to be assessed to determine whether it is indeed closing known quality gaps, as well as eliminating disparities in health care. A potential risk of not doing so is that measurement will be done simply for its own sake, without serving the primary purpose of moving closer to achieving the six quality aims.
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From page 126... ...
Other potential consequences that warrant close monitoring include the potential burden of data collection on the health care system, as well as on individual providers; misclassification of providers, particularly if data are publicly reported; gaming of the system; and adverse selection of healthier patients to improve scores. Perhaps the most serious unintended consequence is that quality gaps will persist, resulting in harm to both patients and communities.
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2002. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care.
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From page 128... ...
Presentation to the IOM Committee on Performance Measures, Pay ment and Performance Improvement Programs, December 13, 2004, Washington, DC. Sepucha KR, Fowler FJ Jr, Mulley AG Jr.
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