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From page 345... ... Index A Acute care performance measures, 11, 106� 107, 206�207 Acceleration Translation of Research into Acute myocardial infarction Practice, 155 mortality measurement, 120 Access to care starter set performance measures, 109, 116 accountability for, 29 Administrative data current measurement of, 3, 117 case studies of data collection, 152, 156, insurance coverage and, 23, 117 158 NQCB rationale, 67 components of performance in rural areas, 24 measurement system, 42�43 starter set of performance measures, current set, 31�32 211�212 limitations, 27, 191�192, 227�228, 234 Accountability opportunities for improvement, 198� for access to care, 29 199, 232�233 goal of NQCB, 7 structural measures of quality, 186 goals for performance measurement Adverse selection, 77, 124, 126 system, 2, 13, 55�56, 98, 167 Advisory Council for Health Care Quality, of NQCB, 8, 9�10, 72�73 47 quality oversight, 25 After-Death Bereaved Family Interview, shared accountability, 84, 88, 97�98, 302, 310�311, 311 122, 123, 168�169 Agency for Healthcare Research and in transitional care, 269 Quality, 43�44 Accreditation capacity for management of national current performance measurement for, system, 65�66 44, 45�46 clinical priority areas for quality quality improvement efforts, 25, 41 improvement, 174 for transitional care, 263, 267 in community-level performance Accreditation Council for Graduate Medical measurement, 97 Education, 25 NQCB and, 8�9, 71�72 345 Read the entire page →
From page 346... ... , 119, 262, Case management, 26 274, 302�303, 313 Case-mix adjustment in performance cost of care and, 20 measurement, 99�100, 121, 192, Alzheimer's disease, 89 258, 261, 269 Ambulatory care Centers for Disease Control and Prevention, current performance measurement 74, 97 programs, 50, 178�179 Centers for Medicare and Medicaid Services information technology implementation, capacity to manage national 26 performance measurement system, patient perspective, 105�106 65�66 starter set of performance measures, 11, clinical priority areas for quality 103�106, 204�206 improvement, 174 Ambulatory care Quality Alliance, 50, 102, composite measures, 93 103, 136�137 current performance measurement American Academy of Pediatrics, 267 programs, 40, 46, 50, 51, 64, 138� American Board of Internal Medicine, 51 139, 262 American Board of Medical Specialties, 25 NQCB and, 8�9, 71�72 American College of Cardiology, 190 performance incentive program, 29 American Diabetes Association, 51 performance measurement program, 41, American Heart Association/American 43�44, 185 Stroke Association, 51 public reporting system, 27, 28 American Medical Association, 49, 50, 179 transitional care assessment, 252, 263� Anderson/Helms Referral Data Inventory, 264 262 Chart review abstraction, 50, 107, 152�153, Antibiotic therapy, 105 269 Assessing Care of Vulnerable Elders, 119, limitations, 191 262, 274, 302�303, 313 opportunities for improvement, 198� Asthma, 50, 104, 205 199, 232�233 Audits of performance measurement system, Chronic illness 3, 77 clinical priority areas for quality data verification, 43 improvement, 173�174, 175 Australia, 52�53 complication rates, 13 coordination of care, 29 definition, 129 B performance measurement, 103, 104 process measures, 186�188 Bridges to Excellence, 25, 51, 230, 232, 265 quality of care assessment framework, Brown Atlas of Dying, 289�302 173 Brown University, 304 shortcomings of current performance measures, 89 C shortcomings of health plan designs, 28, 29 California Healthcare Foundation, 119, trends, 104 262, 265 See also Long-term care; specific disease Canada, 22 Chronic obstructive pulmonary disease, 89 Read the entire page →
From page 347... ... , 45, insurance program disincentives to 105�106, 107, 118�119 quality care, 28�30 Consumer choice measures of efficiency, 226�227 accountability and, 7, 167 performance data for consumers, 27�28 current reporting system and, 27�28, 46 performance measurement methodology, decision quality, 119 122�123 goals of performance measurement physician support for performance system, 2, 31, 43, 167 measurement, 145�148 public reporting formats to enhance, possible negative effects of NQCB 123�124 implementation, 77, 126 See also Access to care quality oversight, 25 Consumer perspective reduced regulatory burden for high ambulatory care performance performance, 31 measurement, 105�106 strategies for implementing performance current efforts to measure, 41, 45, 118 measurement, 144�149 data collection needs, 42 sustaining quality improvement, 148�149 longitudinal experiences of care, 119 in underserved areas, 81 medical decision-making, 119 See also Payment incentives palliative care assessment, 300�301 Cognitive functioning assessment, 294�295 perceptions of current health system Colorado Foundation for Medical Care, 266 performance, 22, 24 Colorectal cancer, 116�117 in performance measurement, 90, 118, Community-level performance 168 measurement, 97 performance report design, 123�124 Community Medicine Associates, 150, 151, quality measurement framework, 173 161�163 starter set of performance measures, Competition, 27 213�214 Composite measures transitional care experiences, 262�263 case study, 152 See also Patient-centered care definition, 91�92 Consumer-Purchaser Disclosure Project, 25 implementation, 93 Continuity of care obstacles to development of, 92�93 measures of, 90 purpose, 13, 88 palliative care assessment, 300�301 rationale, 92 See also Transitions, care in scoring methodology, 93�94, 123 Contract authority of NQCB, 8, 71, 114 Comprehensive measurement Cooperative Cardiovascular Project, 195 Read the entire page →
From page 348... ... 348 INDEX Coordination of care, 28, 29, 75, 92, 108� sample size, 122�123, 188�189, 191 109, 119, 251. See also Transitions, scope of, in health care system, 27 care in See also Electronic health records; Coronary artery disease, 50 Information technology; Performance care delivery, 104 measures; Chart review abstraction mortality measurement, 120 Dementia, 89 performance measurement case studies, Department of Defense, 9, 72 154, 155, 162 Department of Health and Human Services, starter set of performance measures, 8, 45, 71 204�205 Department of Veterans Affairs, 179, 190 See also Acute myocardial infarction Depression, 50 Cost of care service delivery, 104 birth defects, 105 starter set of performance measures, 206 in performance measurement, 91 Diabetes, 149�150 public perception, 24 performance measurement case studies, sources of increases in, 20 154, 155, 156, 157, 160, 162 transitional care, 252 performance measures, 49, 50 uninsurance rates and, 23 service delivery, 31, 104 See also Efficiency of care starter set of performance measures, Costs of performance data collection, 150, 205 199 Diabetes Physician Recognition Program, 51 Crossing the Quality Chasm: A New Health Dialysis centers, 28 System for the 21st Century, 1, 3, 17, Disease registries, 26, 31 53, 84, 172, 173�174 Disease-specific mortality measures, 120, 121 Donabedian model for quality of care D assessment, 170�172 Dyspnea assessment, 294�295 Dartmouth Atlas, 232, 289 Data collection auditing of performance measurement E system, 3, 10, 43, 77 challenges for small firms, 149�150 Effectiveness of care components of performance current health care system, 21�22 measurement, 42�43, 198�199 definition, 130 consumer surveys, 45 goals, 1, 31, 172 cost of, 150, 199 starter set of performance measures, on efficiency of care, 227, 232�235 208�211 to improve performance measurement, Efficiency of care 198�199 case study of physician performance national vs. Read the entire page →
From page 349... ... INDEX 349 performance measurement, 103, 105, Episodic efficiency, 117 225�230 Equitable care productive efficiency, 223 current measurement efforts, 3, 41 quality dimensions of measurement, data collection needs to assess, 13 231�232 definition, 131 research needs, 116�117, 230�238 goals, 1, 31, 172 resource allocation model, 223 NQCB rationale, 67 resource attribution in measurement of, performance measurement goals, 96 235�236 regional variation, 24 risk adjustment and, 227�228, 237 research needs, 117�118 starter set of performance measures, 11, role of NQCB, 7�8 108�109 shortcomings of current health care technical efficiency, 223 system, 2, 23 Elderly, 104 Evidence-based practice Electronic health records NQCB design principles, 166�167 barriers to implementation, 149 organizational characteristics and, 26 current use patterns, 25�26 recommendations for NQCB, 73�74 definition, 129 implementation case studies, 155, 156� 157, 163�164 F NQCB implementation, 10�12, 79�80 role in performance measurement, 167� Family care-giving, 253�254 Federal Employees Health Benefits Program, 168 Electronic prescribing, 25, 106�107 9, 72 Emotional functioning assessment, 294�295 Fee for service definition, 129 End-of-life/palliative care, 173 bereavement assessment, 312 longitudinal measurement and, 89 care planning assessment, 296�299, Food and Drug Administration, 174 Forum for Health Care Quality 307�309 caregiver concerns, 311 Measurement and Reporting, 47 challenges in performance measurement, Foundation for Accountability, 84, 93, 173, 174 287, 313�317 current performance measurement, 173, Funding 287, 288�304 assistance to providers for starter set implementation, 12, 102 definition, 288, 315�316 domains of measurement, 288 to develop national performance performance measurement rationale, measurement system, 6, 53�54 financial incentives for performance 287�288 quality improvement projects, 304�307 measurement, 148 quality of care, 22 National Quality Forum, 49 NQCB, 9, 14, 72�73, 79, 126 recommendations for measurement, 307�313 research needs, 312�313, 317 G site-of-death issues, 313�315, 316 survival time measurement, 317 Goals for health system End-stage renal disease efficiency measurement and, 237�238 mortality measurement, 120 local priorities, 10, 76 NHQR performance measures, 221 performance measure selection and, starter set of performance measures, 11, 192�195 108, 221 performance measurement linkage, 3, 6 Epidemiological research, 74 progress to date, 1�2 Read the entire page →
From page 350... ... 350 INDEX recommendations for, 10 Hospital CAHPS, 119, 262, 273 role of NQCB, 7, 68, 89 Hospital Quality Alliance, 138�139 selective referral, 177, 194�195 Hospital Standardized Mortality Rate Government Accountability Office, 10 model, 121�122 Grantmakers in Health, 14, 126 Hospitals GreenField Health (Oregon) , 149, 150, access, 117 159�160 acute care performance measurement, 106�107 care in transitions, 90, 119 H current performance measurement programs, 40, 45�46, 185, 196�197 Health Insurance Portability and direct outcome measurement, 190�192 Accountability Act, 80 efficiency measurement, 229�230 Health maintenance organizations, 44 health care spending in, 106 Health Plan Employer Data and mortality measurement, 121�122 Information Set, 100 performance incentives, 29 ambulatory care measures, 178�179 public reporting system, 28 features, 44, 196�197 structural measures of quality of care, limitations, 27�28 185�186 record review costs, 152 Hypertension, 50 starter set of performance measures, 107, 208�219 Health plans I consumer decision-making, 27�28 current performance measurement, 27� Indian Health Service, 9, 72 28, 196�197 Infant mortality, 22, 24, 104�105 obstacles to high-quality care in design Information technology of, 28�30 barriers to adoption, 26 provider performance incentives, 28�29, insurance payment disincentives to 41 investment in, 29 stability assessment, 214�215 recent initiatives to improve quality of starter set performance measures, 11, care, 24 107�108, 214�215, 218�219 service delivery monitoring, 31 See also Insurance shortcomings of current practice, 25�26 Health Resources and Services for transitional care, 256�257, 269�270, Administration, 8, 71�72 275 HealthPartners, Inc., 93, 152�154 treatment reminders, 20, 25 Healthy People 2010, 94 See also Data collection Heart failure, 50, 104, 106 Initiative for Pediatric Palliative Care, 305 starter set of performance measures, Innovation 205 NQCB and, 10, 76, 77, 81, 89, 145 Heart/Stroke Physician Recognition system-level measurement and, 97 Program, 51 Institute for Clinical Systems Improvement, Hip fracture treatment, 116�117 152 HIV screening, 105 Institute for Healthcare Improvement, 25, Home health care 229, 304 current performance assessment Institute of Medicine, 1, 10, 172, 173, 174 programs, 46 Insurance public reporting system, 28, 220 access to care and, 23 starter set of performance measures, chronic care benefits, 28 107�108, 220 cost of care and, 20 Home Health Compare, 46 current population coverage, 23 Read the entire page →
From page 351... ... INDEX 351 need for performance measurement for Long-term care system improvement, 32 starter set of performance measures, 11, provider payment systems, 29�30 107�108, 220 in rural areas, 24 See also Chronic illness; Time frame of shortcomings of current system, 2 measures See also Health plans; Medicare; Longitudinal measurement, 167 Uninsured population of continuity and transitions, 90, 119� Integrated Healthcare Association, 51 120 Intensive care, 305 of cost of care, 91 International comparisons of disease-specific mortality, 120 health care spending, 1, 22 efficiency evaluation, 116�117 infant mortality, 104�105 goals of national performance information technology implementation, measurement system, 84, 167 26 of outcomes, 90�91, 108�109, 120 palliative care, 306�307 of pain control, 120 performance measurement efforts, 52�53 rationale, 89�90, 119 quality of care, 1 shortcomings of current system, 87�88 starter set, 108�109 J M Japan, 22 Joint Commission on Accreditation of Mammography, 151, 157 Healthcare Organizations Medicaid budget, 73 consumer decision-making, 28 capacity to manage national current performance measurement in, 44 performance measurement system, 66 See also Centers for Medicare and NQCB and, 64 Medicaid Services performance measurement program, 43� Medicare 44, 45�46, 49, 50, 140�141, 185, charge of Redesigning Health Insurance 230, 256 Performance Measures, Payment, and transitional care assessment, 252, 267� Performance Improvement Project, 268 17�20 Joint replacement, 21 Conditions of Participation, 252, 269 consumer choices, 27 Medicare Advantage Plans, 27, 107 L Medicare Payment Advisory Commission, 10, 73 Leadership and authority Medicare Trust Fund, 9, 72 to develop and implement national NQCB and, 9, 72 performance measurement system, 6, payment incentives and, 20 15, 30, 42, 53, 66, 67, 70, 89 Quality Improvement Organization recommendations for NQCB, 6�7, 8�9, Program, 17�20, 25, 41, 266, 275 69, 71�72, 89 recommendations for public reporting, 9, for research agenda, 114 72 shortcomings of current performance resource consumption patterns, 253 measurement initiatives, 3, 6 See also Centers for Medicare and Leapfrog Group, 25, 107, 140�141, 185, Medicaid Services 230, 232, 265 Medicare Prescription Drug, Improvement, Life expectancy, 22 and Modernization Act (2003) , 2, Local circumstances, NQCB sensitivity to, 106, 174 10, 74, 75�76, 81 Minimum Data Set, 46, 107�108 Read the entire page →
From page 352... ... See also Performance measurement, capacity to manage national national system of performance measurement system, 66 National Quality Forum (NQF) , 142�143 collaborations in performance accomplishments, 48, 143 measurement, 49, 50 acute care performance measurement, functions, 73 106 performance measurement activities, 27� ambulatory care performance 28, 40, 43�44, 51, 64, 140�141, 178, measurement, 50, 178�179 229�230, 231, 232 capacity to manage national transitional care assessment, 265 performance measurement system, National Health Information Network, 24 64, 66 National Healthcare Disparities Report, 118 end-of-life care assessment, 306, 317 National Healthcare Quality Report, 97 funding, 73, 143 National Hospice Data Set, 302 governance, 48, 142 National Institutes of Health, 21 hospital-based care assessment, 185, 229 National Medicaring Quality Improvement origins and development, 47�48 Collaborative, 304 purpose, 48, 73, 142 National Quality Coordination Board quality-of-care assessment, 232, 306 (NQCB) Read the entire page →
From page 353... ... INDEX 353 public reporting system, 28, 220 Patients' Evaluation of Performance in starter set of performance measures, California, 262�263, 265, 271�272 107�108 Payment incentives case study, 159 current health plan shortcomings, 28�29 O current quality improvement efforts, 29, 41 Organizational characteristics goals of Redesigning Health Insurance data collection needs, 42 Performance Measures, Payment, and Donabedian model for quality of care Performance Improvement Project, assessment, 170�172 20 health care system, 27 impact of performance measurement, 7 information technology implementation, need for performance measures to 26 implement, 2, 30�31 NQCB, 78�79 rationale, 31 structural measures of care, 185�186 strategies for health system Osteoarthritis, 50 improvement, 1, 2�3 Outcome and Assessment Information Set, in transitional care, 269 46, 107�108 Pediatric palliative care, 305 Outcomes measurement Performance measurement, national system challenges in provider evaluation, 49, 120 of current quality of care assessment accountability in, 13, 55�56 programs, 190�192 alternatives to, 65�68 disease-specific mortality, 120, 121 challenges to development and in efficiency of care measurement, 116 implementation, 42, 53�54 in end-of-life/palliative care, 313�315 data collection and analysis capabilities hospital-specific mortality, 121�122 for, 42�43 longitudinal measures, 89�91 design principles, 57, 84, 166�169 pain control, 120 desirable attributes, 3, 54�57 process measures and, 186�188, 189 as disincentive to innovation, 77 standardization, 42 evaluation of, 14, 114, 124�126, 169 starter set of performance measures, 11, implementation, 30, 54, 57 108�109 international comparison, 52�53 structural measures, 185�186 leadership needs, 6, 15, 66 in transitional care, 90, 119, 263 lessons from NQF, 49 local considerations, 10 pioneering programs, 43�46 P prospects for health system without, 15, Pain management assessment, 49, 120, 290� 64�65, 79 293, 304, 309�310 public health role, 57 Palliative care. See End-of-life/palliative care quality improvement role, 56�57 Palliative Care Benchmarking, 303 rationale, 2, 3, 15, 30�32, 46�47, 63 Pathways to Quality Health Care reports, recent collaborative efforts, 46�51 2�3, 17�20 resistance to, 69�70, 149 Patient-centered care shortcomings of current initiatives to current measurement efforts, 13, 41 develop, 3�6, 49, 51, 53�54, 64, 68 definition, 118, 130 strategies for implementing, in health health care system goals, 1, 31, 172 care organizations, 144�149 patient-level measurement, 13, 42�43, See also National Quality Coordination 84, 88, 91�92, 95�96, 118�119, 201 Board (NQCB) Read the entire page →
From page 354... ... 354 INDEX Performance Measurement Coordinating transitional care, 261�264, 270�274 Council, 49 See also Performance measurement, Performance measures national system of; Starter set of access to patient-level data, 42�43 performance measures approaches to improve health care, 84� Pharmacy services 86, 87�88 data management, 234�235 care across settings, 89�90, 95 electronic prescribing, 25, 106�107 care across time, 13, 89, 90 public perception of drug costs, 24 case studies of implementation, 150�164 in transitional care, 234�235 chronic care, 104 Physician Consortium for Performance community-level, 97 Improvement, 50, 142�143, 179 composite measures, 13, 88, 91�94 Physician Practice Connections, 51 comprehensive measurement, 84, 87, 88, Pneumonia, 106 89, 95, 115�119, 166 Population-based measurement, 84, 88, 91, condition-specific, 196 94�96, 167 consistency in application, 3 Population-based measures, 13 criteria for selection, 98, 192�196 Preferred provider organizations, 107 current leading sets, 84, 170, 178�179, Prenatal health 185, 196�197 performance measurement, 50, 103, definition, 130 104�105 development methodology, 122�123 starter set of performance measures, 206 efficiency of care, 103, 105, 116�117, President's Advisory Commission on 229�230 Consumer Protection and Quality in end-of-life/palliative care, 288�304, 307� the Health Care Industry, 47 313 Prevention equity of care, 117�118 performance measurement, 50, 103�104 evaluation of, 177�178 population health improvement, 94 longitudinal, 84, 87�88, 89�91, 116� in prenatal care, 105 117, 119�120, 167 process measures of, 186�188 outcome measures, 190�192 role of national performance pain control, 120 measurement system, 57 patient-centered, 13, 84, 88, 91�94, 95� starter set of performance measures, 204 96, 118�119 Prime Care Family Practice, 151, 155�157 population-based, 13, 84, 88, 91, 94�96, Privacy, 27, 80�81 167 Private sector research, 21 prenatal care, 104�105 Process of care measurement, 186�190 preventive care, 103�104 in transitions, 260, 261, 262 procedure-specific, 196 Providers. See Clinicians and providers process measures, 186�190 Public good, 6 rationale, 79, 177, 255�256 Public reporting on performance reliability, 19�201 case studies, 154 research agenda, 114�122, 198�201 current programs, 6, 27�28, 40�41 role of NQCB in developing, 7, 68 evidence of quality improvement from, scope, 12, 89 63�64 shared accountability, 84, 88, 97�98, format design and testing, 14, 15, 114, 122, 168�169 123�124 shortcomings of current set, 12�13, 31� impact of performance measurement, 7 32, 41, 43, 83, 84, 86�98, 99�100, implementation of national system, 57 175 local considerations, 10 standardization requirements, 42, 43 national performance measurement structure measures, 185�186 system and, 2, 3, 15, 30�31, 57 systems-level, 13, 91, 96�97, 121 rationale, 31 Read the entire page →
From page 355... ... INDEX 355 recommendations for Medicare, 9, 72 health care spending and, 1�2, 22 role of NQCB, 7, 67, 68 health plan design as obstacle to, 28�30 strategies for health system impact of performance measurement, 7, improvement, 1 63 Purchasing practices NQCB impact assessment, 124�126 contract authority of NQCB, 8, 71, 114 over time, 13, 89, 90 recent initiatives to improve quality of oversight, 25 care, 25 patient perceptions of, 22, 24 population health, 94 practice characteristics and, 26 Q process measures, 186�190, 260, 261, 262 Quality improvement, 2 public reporting effects on, 63�64 clinical priority areas for, 173�174 role of NQCB, 7, 74�75, 80 collaboratives, 1 scope of measurement, 12 consumer advocacy for, 27 structural measures, 185�186, 260�261 current efforts, 1�2, 24�25, 41 in transitions, 250, 254�255 definition, 131 See also Quality improvement end-of-life/palliative care, 304�305 Quality of Care for Oncologic Conditions environmental barriers to, 26 and HIV, 303�304 government regulation for, 30 market incentives for, 27, 30 need for performance measures for, 2, 3, R 15, 30�32, 56�57 obstacles to, 2 Race/ethnicity organizations, 17�20 current inequities in health system, 2, 23 professional education and monitoring data collection needs, 13, 118 for, 30 treatment outcome disparities, 103�104, sustaining, after performance 118 measurement implementation, 148� treatment outcome measurement, 120 149 RAND Corporation, 93, 197, 262, 303�304 in transitional care, 255�261, 264�270 Redesigning Health Insurance Performance See also Quality of care Measures, Payment, and Performance Quality Improvement Organizations. See Improvement Project, 2�3, 17, 24 Medicare, Quality Improvement Regional variation Organization Program disparities in care, 118 Quality of care health care spending, 2, 22 analytic frameworks for assessing, 84, quality of care, 2, 22 170, 201 Regulation to improve quality of care, 30 case studies of performance reduced regulatory burden for high measurement implementation, 150� performance providers, 31 164 Research changes needed to improve, 17 current system, 21, 114 cost of care and, 20 efficiency of care measurement, 230�238 current physician recognition programs, to improve performance measurement, 51 198�201 current system, 21�22, 25�26 NQCB agenda. Read the entire page →
From page 356... ... 356 INDEX Research agenda for NQCB Society for Hospital Medicine, 266 components, 14, 113�114 Society for Thoracic Surgeons, 190 contracting and grantmaking authority, Socioeconomic status 114 current inequities in health system, 2 efficiency of care, 116�117 data collection needs, 13, 118 funding, 14 Spending goals, 7, 68, 74�75, 109, 113, 115 consumer health care, 22 new measure development and current research system, 21 implementation, 114�123 electronic health record implementation, participants, 14�15, 126 155, 156�157, 163�164 performance measurement system in hospitals, 106 evaluation, 124�126 patient record review costs, 152�154, recommendations, 14�15, 114, 126 162 Risk adjustment, 67, 77 physician performance profiling system, definition, 131 158 direct outcome measurement and, 191� quality of care and, 1�2, 22 192 regional variation, 2, 22 efficiency measurement and, 227�228, in transitional care, 252�253 237 See also Cost of care limitations of current system, 6, 67, 77, Standardization of data 99�100 characteristics, 42 research recommendations, 14, 114, current system, 43, 67 122 efficiency measures, 231 Robert Wood Johnson Foundation, 305 rationale, 42 Rochester Individual Practice Association, resistance to national program for, 69� 158�159 70 Rural areas, 81 role of NQCB, 78�79, 83 access to care in, 24, 117 Standards-setting authority of NQCB, 8�9, NQCB implementation, 81, 84 71�72 local considerations, 10 Starter set of performance measures, 204� S 221 acute care, 11, 106�107, 206�207 Safety of care ambulatory care, 11, 103�106, 204�206 current health care system, 21�22 development methodology, 84, 170, definition, 130 174�175 goals, 1, 31, 172 efficiency of care, 11, 108�109 recent initiatives to improve, 24�25 end-stage renal disease, 11, 108 in transitions, 254�255 health plans, 11, 107 Scope of performance measurement, 12 long-term care, 11, 107�108 Selective referral, 177, 194�195 obstacles to implementation, 84, 100�102 Shared accountability, 84, 88, 97�98, 122, recommendations, 10�12, 100, 102 123, 168�169 Strategic Framework Board, 48 Small practice settings Stroke, 89 challenges to quality improvement in, 17 Structural measures of quality of care, 185� data collection for performance 186, 260�261 comparison, 28, 49 Surgery information technology implementation, complications, 106 25 direct outcome measurement, 190 obstacles to performance measurement, Symptom Management/End-of-Life, 306 49, 149�150 System-level measurement, 13, 84, 88, 91, sustaining quality improvement, 148�149 96�97, 121�122 Read the entire page →
From page 357... ... INDEX 357 T process measures of quality of care, 260, 261, 262 Technological advancement in medicine quality problems in, 254�255 accomplishments, 21 recommendations for performance cost of care and, 20 measurement, 270�274 Time frame of measures, 89, 90 to self-care, 253 efficiency measurement, 116, 233�234 significance of, for quality improvement, long-term care, 11, 90, 107�108, 220 250 shortcomings of current system, 13, 89 strategies for improving measurement, Timeliness of care 274�275 definition, 130 structural measures of quality of care, goals, 1, 31, 172 260�261 To Err Is Human: Building a Safer Health Transplantation, organ, 21 System, 1 Treatment reminders, 20, 25, 26 Tobacco cessation programs, 104, 106 TRICARE program, 9, 72 Transitions, care in accountability in, 269 barriers to quality improvement, 268� U 270 barriers to quality in, 250, 251�252 Uninsured population case-mix adjustment in performance access to care, 23 measurement, 269 economic outcomes, 23 current performance measures, 261�264, patterns and trends, 2, 23 280�286 United Hospital Fund, 304 current quality improvement efforts, United Kingdom, 22, 52, 306 264�268 University of Colorado Health Science data sources, 259 Center, 119 definition, 90, 129, 250�251 U.S. Preventive Services Task Force, 161 elements of, 251 Utilization family care-giving in, 253�254 end-of-life care, 314�315 goals, 251 starter set of performance measures, health care setting considerations, 259� 215�218 260 information technology in, 269�270, 275 V medical information transfer in, 235, Value-based purchasing, 41 256�257 Veterans Health Administration, 9, 63, 72, patterns and trends, 253 304 performance measurement, 90, 119, Vulnerable populations, 131 255�261 Read the entire page →

From page 345...

... Index A Acute care performance measures, 11, 106� 107, 206�207 Acceleration Translation of Research into Acute myocardial infarction Practice, 155 mortality measurement, 120 Access to care starter set performance measures, 109, 116 accountability for, 29 Administrative data current measurement of, 3, 117 case studies of data collection, 152, 156, insurance coverage and, 23, 117 158 NQCB rationale, 67 components of performance in rural areas, 24 measurement system, 42�43 starter set of performance measures, current set, 31�32 211�212 limitations, 27, 191�192, 227�228, 234 Accountability opportunities for improvement, 198� for access to care, 29 199, 232�233 goal of NQCB, 7 structural measures of quality, 186 goals for performance measurement Adverse selection, 77, 124, 126 system, 2, 13, 55�56, 98, 167 Advisory Council for Health Care Quality, of NQCB, 8, 9�10, 72�73 47 quality oversight, 25 After-Death Bereaved Family Interview, shared accountability, 84, 88, 97�98, 302, 310�311, 311 122, 123, 168�169 Agency for Healthcare Research and in transitional care, 269 Quality, 43�44 Accreditation capacity for management of national current performance measurement for, system, 65�66 44, 45�46 clinical priority areas for quality quality improvement efforts, 25, 41 improvement, 174 for transitional care, 263, 267 in community-level performance Accreditation Council for Graduate Medical measurement, 97 Education, 25 NQCB and, 8�9, 71�72 345

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From page 346...

... , 119, 262, Case management, 26 274, 302�303, 313 Case-mix adjustment in performance cost of care and, 20 measurement, 99�100, 121, 192, Alzheimer's disease, 89 258, 261, 269 Ambulatory care Centers for Disease Control and Prevention, current performance measurement 74, 97 programs, 50, 178�179 Centers for Medicare and Medicaid Services information technology implementation, capacity to manage national 26 performance measurement system, patient perspective, 105�106 65�66 starter set of performance measures, 11, clinical priority areas for quality 103�106, 204�206 improvement, 174 Ambulatory care Quality Alliance, 50, 102, composite measures, 93 103, 136�137 current performance measurement American Academy of Pediatrics, 267 programs, 40, 46, 50, 51, 64, 138� American Board of Internal Medicine, 51 139, 262 American Board of Medical Specialties, 25 NQCB and, 8�9, 71�72 American College of Cardiology, 190 performance incentive program, 29 American Diabetes Association, 51 performance measurement program, 41, American Heart Association/American 43�44, 185 Stroke Association, 51 public reporting system, 27, 28 American Medical Association, 49, 50, 179 transitional care assessment, 252, 263� Anderson/Helms Referral Data Inventory, 264 262 Chart review abstraction, 50, 107, 152�153, Antibiotic therapy, 105 269 Assessing Care of Vulnerable Elders, 119, limitations, 191 262, 274, 302�303, 313 opportunities for improvement, 198� Asthma, 50, 104, 205 199, 232�233 Audits of performance measurement system, Chronic illness 3, 77 clinical priority areas for quality data verification, 43 improvement, 173�174, 175 Australia, 52�53 complication rates, 13 coordination of care, 29 definition, 129 B performance measurement, 103, 104 process measures, 186�188 Bridges to Excellence, 25, 51, 230, 232, 265 quality of care assessment framework, Brown Atlas of Dying, 289�302 173 Brown University, 304 shortcomings of current performance measures, 89 C shortcomings of health plan designs, 28, 29 California Healthcare Foundation, 119, trends, 104 262, 265 See also Long-term care; specific disease Canada, 22 Chronic obstructive pulmonary disease, 89

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From page 347...

... , 45, insurance program disincentives to 105�106, 107, 118�119 quality care, 28�30 Consumer choice measures of efficiency, 226�227 accountability and, 7, 167 performance data for consumers, 27�28 current reporting system and, 27�28, 46 performance measurement methodology, decision quality, 119 122�123 goals of performance measurement physician support for performance system, 2, 31, 43, 167 measurement, 145�148 public reporting formats to enhance, possible negative effects of NQCB 123�124 implementation, 77, 126 See also Access to care quality oversight, 25 Consumer perspective reduced regulatory burden for high ambulatory care performance performance, 31 measurement, 105�106 strategies for implementing performance current efforts to measure, 41, 45, 118 measurement, 144�149 data collection needs, 42 sustaining quality improvement, 148�149 longitudinal experiences of care, 119 in underserved areas, 81 medical decision-making, 119 See also Payment incentives palliative care assessment, 300�301 Cognitive functioning assessment, 294�295 perceptions of current health system Colorado Foundation for Medical Care, 266 performance, 22, 24 Colorectal cancer, 116�117 in performance measurement, 90, 118, Community-level performance 168 measurement, 97 performance report design, 123�124 Community Medicine Associates, 150, 151, quality measurement framework, 173 161�163 starter set of performance measures, Competition, 27 213�214 Composite measures transitional care experiences, 262�263 case study, 152 See also Patient-centered care definition, 91�92 Consumer-Purchaser Disclosure Project, 25 implementation, 93 Continuity of care obstacles to development of, 92�93 measures of, 90 purpose, 13, 88 palliative care assessment, 300�301 rationale, 92 See also Transitions, care in scoring methodology, 93�94, 123 Contract authority of NQCB, 8, 71, 114 Comprehensive measurement Cooperative Cardiovascular Project, 195

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From page 348...

... 348 INDEX Coordination of care, 28, 29, 75, 92, 108� sample size, 122�123, 188�189, 191 109, 119, 251. See also Transitions, scope of, in health care system, 27 care in See also Electronic health records; Coronary artery disease, 50 Information technology; Performance care delivery, 104 measures; Chart review abstraction mortality measurement, 120 Dementia, 89 performance measurement case studies, Department of Defense, 9, 72 154, 155, 162 Department of Health and Human Services, starter set of performance measures, 8, 45, 71 204�205 Department of Veterans Affairs, 179, 190 See also Acute myocardial infarction Depression, 50 Cost of care service delivery, 104 birth defects, 105 starter set of performance measures, 206 in performance measurement, 91 Diabetes, 149�150 public perception, 24 performance measurement case studies, sources of increases in, 20 154, 155, 156, 157, 160, 162 transitional care, 252 performance measures, 49, 50 uninsurance rates and, 23 service delivery, 31, 104 See also Efficiency of care starter set of performance measures, Costs of performance data collection, 150, 205 199 Diabetes Physician Recognition Program, 51 Crossing the Quality Chasm: A New Health Dialysis centers, 28 System for the 21st Century, 1, 3, 17, Disease registries, 26, 31 53, 84, 172, 173�174 Disease-specific mortality measures, 120, 121 Donabedian model for quality of care D assessment, 170�172 Dyspnea assessment, 294�295 Dartmouth Atlas, 232, 289 Data collection auditing of performance measurement E system, 3, 10, 43, 77 challenges for small firms, 149�150 Effectiveness of care components of performance current health care system, 21�22 measurement, 42�43, 198�199 definition, 130 consumer surveys, 45 goals, 1, 31, 172 cost of, 150, 199 starter set of performance measures, on efficiency of care, 227, 232�235 208�211 to improve performance measurement, Efficiency of care 198�199 case study of physician performance national vs.

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From page 349...

... INDEX 349 performance measurement, 103, 105, Episodic efficiency, 117 225�230 Equitable care productive efficiency, 223 current measurement efforts, 3, 41 quality dimensions of measurement, data collection needs to assess, 13 231�232 definition, 131 research needs, 116�117, 230�238 goals, 1, 31, 172 resource allocation model, 223 NQCB rationale, 67 resource attribution in measurement of, performance measurement goals, 96 235�236 regional variation, 24 risk adjustment and, 227�228, 237 research needs, 117�118 starter set of performance measures, 11, role of NQCB, 7�8 108�109 shortcomings of current health care technical efficiency, 223 system, 2, 23 Elderly, 104 Evidence-based practice Electronic health records NQCB design principles, 166�167 barriers to implementation, 149 organizational characteristics and, 26 current use patterns, 25�26 recommendations for NQCB, 73�74 definition, 129 implementation case studies, 155, 156� 157, 163�164 F NQCB implementation, 10�12, 79�80 role in performance measurement, 167� Family care-giving, 253�254 Federal Employees Health Benefits Program, 168 Electronic prescribing, 25, 106�107 9, 72 Emotional functioning assessment, 294�295 Fee for service definition, 129 End-of-life/palliative care, 173 bereavement assessment, 312 longitudinal measurement and, 89 care planning assessment, 296�299, Food and Drug Administration, 174 Forum for Health Care Quality 307�309 caregiver concerns, 311 Measurement and Reporting, 47 challenges in performance measurement, Foundation for Accountability, 84, 93, 173, 174 287, 313�317 current performance measurement, 173, Funding 287, 288�304 assistance to providers for starter set implementation, 12, 102 definition, 288, 315�316 domains of measurement, 288 to develop national performance performance measurement rationale, measurement system, 6, 53�54 financial incentives for performance 287�288 quality improvement projects, 304�307 measurement, 148 quality of care, 22 National Quality Forum, 49 NQCB, 9, 14, 72�73, 79, 126 recommendations for measurement, 307�313 research needs, 312�313, 317 G site-of-death issues, 313�315, 316 survival time measurement, 317 Goals for health system End-stage renal disease efficiency measurement and, 237�238 mortality measurement, 120 local priorities, 10, 76 NHQR performance measures, 221 performance measure selection and, starter set of performance measures, 11, 192�195 108, 221 performance measurement linkage, 3, 6 Epidemiological research, 74 progress to date, 1�2

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From page 350...

... 350 INDEX recommendations for, 10 Hospital CAHPS, 119, 262, 273 role of NQCB, 7, 68, 89 Hospital Quality Alliance, 138�139 selective referral, 177, 194�195 Hospital Standardized Mortality Rate Government Accountability Office, 10 model, 121�122 Grantmakers in Health, 14, 126 Hospitals GreenField Health (Oregon) , 149, 150, access, 117 159�160 acute care performance measurement, 106�107 care in transitions, 90, 119 H current performance measurement programs, 40, 45�46, 185, 196�197 Health Insurance Portability and direct outcome measurement, 190�192 Accountability Act, 80 efficiency measurement, 229�230 Health maintenance organizations, 44 health care spending in, 106 Health Plan Employer Data and mortality measurement, 121�122 Information Set, 100 performance incentives, 29 ambulatory care measures, 178�179 public reporting system, 28 features, 44, 196�197 structural measures of quality of care, limitations, 27�28 185�186 record review costs, 152 Hypertension, 50 starter set of performance measures, 107, 208�219 Health plans I consumer decision-making, 27�28 current performance measurement, 27� Indian Health Service, 9, 72 28, 196�197 Infant mortality, 22, 24, 104�105 obstacles to high-quality care in design Information technology of, 28�30 barriers to adoption, 26 provider performance incentives, 28�29, insurance payment disincentives to 41 investment in, 29 stability assessment, 214�215 recent initiatives to improve quality of starter set performance measures, 11, care, 24 107�108, 214�215, 218�219 service delivery monitoring, 31 See also Insurance shortcomings of current practice, 25�26 Health Resources and Services for transitional care, 256�257, 269�270, Administration, 8, 71�72 275 HealthPartners, Inc., 93, 152�154 treatment reminders, 20, 25 Healthy People 2010, 94 See also Data collection Heart failure, 50, 104, 106 Initiative for Pediatric Palliative Care, 305 starter set of performance measures, Innovation 205 NQCB and, 10, 76, 77, 81, 89, 145 Heart/Stroke Physician Recognition system-level measurement and, 97 Program, 51 Institute for Clinical Systems Improvement, Hip fracture treatment, 116�117 152 HIV screening, 105 Institute for Healthcare Improvement, 25, Home health care 229, 304 current performance assessment Institute of Medicine, 1, 10, 172, 173, 174 programs, 46 Insurance public reporting system, 28, 220 access to care and, 23 starter set of performance measures, chronic care benefits, 28 107�108, 220 cost of care and, 20 Home Health Compare, 46 current population coverage, 23

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From page 351...

... INDEX 351 need for performance measurement for Long-term care system improvement, 32 starter set of performance measures, 11, provider payment systems, 29�30 107�108, 220 in rural areas, 24 See also Chronic illness; Time frame of shortcomings of current system, 2 measures See also Health plans; Medicare; Longitudinal measurement, 167 Uninsured population of continuity and transitions, 90, 119� Integrated Healthcare Association, 51 120 Intensive care, 305 of cost of care, 91 International comparisons of disease-specific mortality, 120 health care spending, 1, 22 efficiency evaluation, 116�117 infant mortality, 104�105 goals of national performance information technology implementation, measurement system, 84, 167 26 of outcomes, 90�91, 108�109, 120 palliative care, 306�307 of pain control, 120 performance measurement efforts, 52�53 rationale, 89�90, 119 quality of care, 1 shortcomings of current system, 87�88 starter set, 108�109 J M Japan, 22 Joint Commission on Accreditation of Mammography, 151, 157 Healthcare Organizations Medicaid budget, 73 consumer decision-making, 28 capacity to manage national current performance measurement in, 44 performance measurement system, 66 See also Centers for Medicare and NQCB and, 64 Medicaid Services performance measurement program, 43� Medicare 44, 45�46, 49, 50, 140�141, 185, charge of Redesigning Health Insurance 230, 256 Performance Measures, Payment, and transitional care assessment, 252, 267� Performance Improvement Project, 268 17�20 Joint replacement, 21 Conditions of Participation, 252, 269 consumer choices, 27 Medicare Advantage Plans, 27, 107 L Medicare Payment Advisory Commission, 10, 73 Leadership and authority Medicare Trust Fund, 9, 72 to develop and implement national NQCB and, 9, 72 performance measurement system, 6, payment incentives and, 20 15, 30, 42, 53, 66, 67, 70, 89 Quality Improvement Organization recommendations for NQCB, 6�7, 8�9, Program, 17�20, 25, 41, 266, 275 69, 71�72, 89 recommendations for public reporting, 9, for research agenda, 114 72 shortcomings of current performance resource consumption patterns, 253 measurement initiatives, 3, 6 See also Centers for Medicare and Leapfrog Group, 25, 107, 140�141, 185, Medicaid Services 230, 232, 265 Medicare Prescription Drug, Improvement, Life expectancy, 22 and Modernization Act (2003) , 2, Local circumstances, NQCB sensitivity to, 106, 174 10, 74, 75�76, 81 Minimum Data Set, 46, 107�108

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From page 352...

... See also Performance measurement, capacity to manage national national system of performance measurement system, 66 National Quality Forum (NQF) , 142�143 collaborations in performance accomplishments, 48, 143 measurement, 49, 50 acute care performance measurement, functions, 73 106 performance measurement activities, 27� ambulatory care performance 28, 40, 43�44, 51, 64, 140�141, 178, measurement, 50, 178�179 229�230, 231, 232 capacity to manage national transitional care assessment, 265 performance measurement system, National Health Information Network, 24 64, 66 National Healthcare Disparities Report, 118 end-of-life care assessment, 306, 317 National Healthcare Quality Report, 97 funding, 73, 143 National Hospice Data Set, 302 governance, 48, 142 National Institutes of Health, 21 hospital-based care assessment, 185, 229 National Medicaring Quality Improvement origins and development, 47�48 Collaborative, 304 purpose, 48, 73, 142 National Quality Coordination Board quality-of-care assessment, 232, 306 (NQCB)

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From page 353...

... INDEX 353 public reporting system, 28, 220 Patients' Evaluation of Performance in starter set of performance measures, California, 262�263, 265, 271�272 107�108 Payment incentives case study, 159 current health plan shortcomings, 28�29 O current quality improvement efforts, 29, 41 Organizational characteristics goals of Redesigning Health Insurance data collection needs, 42 Performance Measures, Payment, and Donabedian model for quality of care Performance Improvement Project, assessment, 170�172 20 health care system, 27 impact of performance measurement, 7 information technology implementation, need for performance measures to 26 implement, 2, 30�31 NQCB, 78�79 rationale, 31 structural measures of care, 185�186 strategies for health system Osteoarthritis, 50 improvement, 1, 2�3 Outcome and Assessment Information Set, in transitional care, 269 46, 107�108 Pediatric palliative care, 305 Outcomes measurement Performance measurement, national system challenges in provider evaluation, 49, 120 of current quality of care assessment accountability in, 13, 55�56 programs, 190�192 alternatives to, 65�68 disease-specific mortality, 120, 121 challenges to development and in efficiency of care measurement, 116 implementation, 42, 53�54 in end-of-life/palliative care, 313�315 data collection and analysis capabilities hospital-specific mortality, 121�122 for, 42�43 longitudinal measures, 89�91 design principles, 57, 84, 166�169 pain control, 120 desirable attributes, 3, 54�57 process measures and, 186�188, 189 as disincentive to innovation, 77 standardization, 42 evaluation of, 14, 114, 124�126, 169 starter set of performance measures, 11, implementation, 30, 54, 57 108�109 international comparison, 52�53 structural measures, 185�186 leadership needs, 6, 15, 66 in transitional care, 90, 119, 263 lessons from NQF, 49 local considerations, 10 pioneering programs, 43�46 P prospects for health system without, 15, Pain management assessment, 49, 120, 290� 64�65, 79 293, 304, 309�310 public health role, 57 Palliative care. See End-of-life/palliative care quality improvement role, 56�57 Palliative Care Benchmarking, 303 rationale, 2, 3, 15, 30�32, 46�47, 63 Pathways to Quality Health Care reports, recent collaborative efforts, 46�51 2�3, 17�20 resistance to, 69�70, 149 Patient-centered care shortcomings of current initiatives to current measurement efforts, 13, 41 develop, 3�6, 49, 51, 53�54, 64, 68 definition, 118, 130 strategies for implementing, in health health care system goals, 1, 31, 172 care organizations, 144�149 patient-level measurement, 13, 42�43, See also National Quality Coordination 84, 88, 91�92, 95�96, 118�119, 201 Board (NQCB)

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From page 354...

... 354 INDEX Performance Measurement Coordinating transitional care, 261�264, 270�274 Council, 49 See also Performance measurement, Performance measures national system of; Starter set of access to patient-level data, 42�43 performance measures approaches to improve health care, 84� Pharmacy services 86, 87�88 data management, 234�235 care across settings, 89�90, 95 electronic prescribing, 25, 106�107 care across time, 13, 89, 90 public perception of drug costs, 24 case studies of implementation, 150�164 in transitional care, 234�235 chronic care, 104 Physician Consortium for Performance community-level, 97 Improvement, 50, 142�143, 179 composite measures, 13, 88, 91�94 Physician Practice Connections, 51 comprehensive measurement, 84, 87, 88, Pneumonia, 106 89, 95, 115�119, 166 Population-based measurement, 84, 88, 91, condition-specific, 196 94�96, 167 consistency in application, 3 Population-based measures, 13 criteria for selection, 98, 192�196 Preferred provider organizations, 107 current leading sets, 84, 170, 178�179, Prenatal health 185, 196�197 performance measurement, 50, 103, definition, 130 104�105 development methodology, 122�123 starter set of performance measures, 206 efficiency of care, 103, 105, 116�117, President's Advisory Commission on 229�230 Consumer Protection and Quality in end-of-life/palliative care, 288�304, 307� the Health Care Industry, 47 313 Prevention equity of care, 117�118 performance measurement, 50, 103�104 evaluation of, 177�178 population health improvement, 94 longitudinal, 84, 87�88, 89�91, 116� in prenatal care, 105 117, 119�120, 167 process measures of, 186�188 outcome measures, 190�192 role of national performance pain control, 120 measurement system, 57 patient-centered, 13, 84, 88, 91�94, 95� starter set of performance measures, 204 96, 118�119 Prime Care Family Practice, 151, 155�157 population-based, 13, 84, 88, 91, 94�96, Privacy, 27, 80�81 167 Private sector research, 21 prenatal care, 104�105 Process of care measurement, 186�190 preventive care, 103�104 in transitions, 260, 261, 262 procedure-specific, 196 Providers. See Clinicians and providers process measures, 186�190 Public good, 6 rationale, 79, 177, 255�256 Public reporting on performance reliability, 19�201 case studies, 154 research agenda, 114�122, 198�201 current programs, 6, 27�28, 40�41 role of NQCB in developing, 7, 68 evidence of quality improvement from, scope, 12, 89 63�64 shared accountability, 84, 88, 97�98, format design and testing, 14, 15, 114, 122, 168�169 123�124 shortcomings of current set, 12�13, 31� impact of performance measurement, 7 32, 41, 43, 83, 84, 86�98, 99�100, implementation of national system, 57 175 local considerations, 10 standardization requirements, 42, 43 national performance measurement structure measures, 185�186 system and, 2, 3, 15, 30�31, 57 systems-level, 13, 91, 96�97, 121 rationale, 31

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From page 355...

... INDEX 355 recommendations for Medicare, 9, 72 health care spending and, 1�2, 22 role of NQCB, 7, 67, 68 health plan design as obstacle to, 28�30 strategies for health system impact of performance measurement, 7, improvement, 1 63 Purchasing practices NQCB impact assessment, 124�126 contract authority of NQCB, 8, 71, 114 over time, 13, 89, 90 recent initiatives to improve quality of oversight, 25 care, 25 patient perceptions of, 22, 24 population health, 94 practice characteristics and, 26 Q process measures, 186�190, 260, 261, 262 Quality improvement, 2 public reporting effects on, 63�64 clinical priority areas for, 173�174 role of NQCB, 7, 74�75, 80 collaboratives, 1 scope of measurement, 12 consumer advocacy for, 27 structural measures, 185�186, 260�261 current efforts, 1�2, 24�25, 41 in transitions, 250, 254�255 definition, 131 See also Quality improvement end-of-life/palliative care, 304�305 Quality of Care for Oncologic Conditions environmental barriers to, 26 and HIV, 303�304 government regulation for, 30 market incentives for, 27, 30 need for performance measures for, 2, 3, R 15, 30�32, 56�57 obstacles to, 2 Race/ethnicity organizations, 17�20 current inequities in health system, 2, 23 professional education and monitoring data collection needs, 13, 118 for, 30 treatment outcome disparities, 103�104, sustaining, after performance 118 measurement implementation, 148� treatment outcome measurement, 120 149 RAND Corporation, 93, 197, 262, 303�304 in transitional care, 255�261, 264�270 Redesigning Health Insurance Performance See also Quality of care Measures, Payment, and Performance Quality Improvement Organizations. See Improvement Project, 2�3, 17, 24 Medicare, Quality Improvement Regional variation Organization Program disparities in care, 118 Quality of care health care spending, 2, 22 analytic frameworks for assessing, 84, quality of care, 2, 22 170, 201 Regulation to improve quality of care, 30 case studies of performance reduced regulatory burden for high measurement implementation, 150� performance providers, 31 164 Research changes needed to improve, 17 current system, 21, 114 cost of care and, 20 efficiency of care measurement, 230�238 current physician recognition programs, to improve performance measurement, 51 198�201 current system, 21�22, 25�26 NQCB agenda.

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From page 356...

... 356 INDEX Research agenda for NQCB Society for Hospital Medicine, 266 components, 14, 113�114 Society for Thoracic Surgeons, 190 contracting and grantmaking authority, Socioeconomic status 114 current inequities in health system, 2 efficiency of care, 116�117 data collection needs, 13, 118 funding, 14 Spending goals, 7, 68, 74�75, 109, 113, 115 consumer health care, 22 new measure development and current research system, 21 implementation, 114�123 electronic health record implementation, participants, 14�15, 126 155, 156�157, 163�164 performance measurement system in hospitals, 106 evaluation, 124�126 patient record review costs, 152�154, recommendations, 14�15, 114, 126 162 Risk adjustment, 67, 77 physician performance profiling system, definition, 131 158 direct outcome measurement and, 191� quality of care and, 1�2, 22 192 regional variation, 2, 22 efficiency measurement and, 227�228, in transitional care, 252�253 237 See also Cost of care limitations of current system, 6, 67, 77, Standardization of data 99�100 characteristics, 42 research recommendations, 14, 114, current system, 43, 67 122 efficiency measures, 231 Robert Wood Johnson Foundation, 305 rationale, 42 Rochester Individual Practice Association, resistance to national program for, 69� 158�159 70 Rural areas, 81 role of NQCB, 78�79, 83 access to care in, 24, 117 Standards-setting authority of NQCB, 8�9, NQCB implementation, 81, 84 71�72 local considerations, 10 Starter set of performance measures, 204� S 221 acute care, 11, 106�107, 206�207 Safety of care ambulatory care, 11, 103�106, 204�206 current health care system, 21�22 development methodology, 84, 170, definition, 130 174�175 goals, 1, 31, 172 efficiency of care, 11, 108�109 recent initiatives to improve, 24�25 end-stage renal disease, 11, 108 in transitions, 254�255 health plans, 11, 107 Scope of performance measurement, 12 long-term care, 11, 107�108 Selective referral, 177, 194�195 obstacles to implementation, 84, 100�102 Shared accountability, 84, 88, 97�98, 122, recommendations, 10�12, 100, 102 123, 168�169 Strategic Framework Board, 48 Small practice settings Stroke, 89 challenges to quality improvement in, 17 Structural measures of quality of care, 185� data collection for performance 186, 260�261 comparison, 28, 49 Surgery information technology implementation, complications, 106 25 direct outcome measurement, 190 obstacles to performance measurement, Symptom Management/End-of-Life, 306 49, 149�150 System-level measurement, 13, 84, 88, 91, sustaining quality improvement, 148�149 96�97, 121�122

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From page 357...

... INDEX 357 T process measures of quality of care, 260, 261, 262 Technological advancement in medicine quality problems in, 254�255 accomplishments, 21 recommendations for performance cost of care and, 20 measurement, 270�274 Time frame of measures, 89, 90 to self-care, 253 efficiency measurement, 116, 233�234 significance of, for quality improvement, long-term care, 11, 90, 107�108, 220 250 shortcomings of current system, 13, 89 strategies for improving measurement, Timeliness of care 274�275 definition, 130 structural measures of quality of care, goals, 1, 31, 172 260�261 To Err Is Human: Building a Safer Health Transplantation, organ, 21 System, 1 Treatment reminders, 20, 25, 26 Tobacco cessation programs, 104, 106 TRICARE program, 9, 72 Transitions, care in accountability in, 269 barriers to quality improvement, 268� U 270 barriers to quality in, 250, 251�252 Uninsured population case-mix adjustment in performance access to care, 23 measurement, 269 economic outcomes, 23 current performance measures, 261�264, patterns and trends, 2, 23 280�286 United Hospital Fund, 304 current quality improvement efforts, United Kingdom, 22, 52, 306 264�268 University of Colorado Health Science data sources, 259 Center, 119 definition, 90, 129, 250�251 U.S. Preventive Services Task Force, 161 elements of, 251 Utilization family care-giving in, 253�254 end-of-life care, 314�315 goals, 251 starter set of performance measures, health care setting considerations, 259� 215�218 260 information technology in, 269�270, 275 V medical information transfer in, 235, Value-based purchasing, 41 256�257 Veterans Health Administration, 9, 63, 72, patterns and trends, 253 304 performance measurement, 90, 119, Vulnerable populations, 131 255�261

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Key Terms

performance measurement

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Index Pages 345-358

Index
Pages 345-358