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From page 345... ...
Index A Acute care performance measures, 11, 106 107, 206207 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, 4243 starter set of performance measures, current set, 3132 211212 limitations, 27, 191192, 227228, 234 Accountability opportunities for improvement, 198 for access to care, 29 199, 232233 goal of NQCB, 7 structural measures of quality, 186 goals for performance measurement Adverse selection, 77, 124, 126 system, 2, 13, 5556, 98, 167 Advisory Council for Health Care Quality, of NQCB, 8, 910, 7273 47 quality oversight, 25 After-Death Bereaved Family Interview, shared accountability, 84, 88, 9798, 302, 310311, 311 122, 123, 168169 Agency for Healthcare Research and in transitional care, 269 Quality, 4344 Accreditation capacity for management of national current performance measurement for, system, 6566 44, 4546 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, 89, 7172 345
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From page 346... ...
, 119, 262, Case management, 26 274, 302303, 313 Case-mix adjustment in performance cost of care and, 20 measurement, 99100, 121, 192, Alzheimer's disease, 89 258, 261, 269 Ambulatory care Centers for Disease Control and Prevention, current performance measurement 74, 97 programs, 50, 178179 Centers for Medicare and Medicaid Services information technology implementation, capacity to manage national 26 performance measurement system, patient perspective, 105106 6566 starter set of performance measures, 11, clinical priority areas for quality 103106, 204206 improvement, 174 Ambulatory care Quality Alliance, 50, 102, composite measures, 93 103, 136137 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, 89, 7172 American College of Cardiology, 190 performance incentive program, 29 American Diabetes Association, 51 performance measurement program, 41, American Heart Association/American 4344, 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, 152153, Antibiotic therapy, 105 269 Assessing Care of Vulnerable Elders, 119, limitations, 191 262, 274, 302303, 313 opportunities for improvement, 198 Asthma, 50, 104, 205 199, 232233 Audits of performance measurement system, Chronic illness 3, 77 clinical priority areas for quality data verification, 43 improvement, 173174, 175 Australia, 5253 complication rates, 13 coordination of care, 29 definition, 129 B performance measurement, 103, 104 process measures, 186188 Bridges to Excellence, 25, 51, 230, 232, 265 quality of care assessment framework, Brown Atlas of Dying, 289302 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 105106, 107, 118119 quality care, 2830 Consumer choice measures of efficiency, 226227 accountability and, 7, 167 performance data for consumers, 2728 current reporting system and, 2728, 46 performance measurement methodology, decision quality, 119 122123 goals of performance measurement physician support for performance system, 2, 31, 43, 167 measurement, 145148 public reporting formats to enhance, possible negative effects of NQCB 123124 implementation, 77, 126 See also Access to care quality oversight, 25 Consumer perspective reduced regulatory burden for high ambulatory care performance performance, 31 measurement, 105106 strategies for implementing performance current efforts to measure, 41, 45, 118 measurement, 144149 data collection needs, 42 sustaining quality improvement, 148149 longitudinal experiences of care, 119 in underserved areas, 81 medical decision-making, 119 See also Payment incentives palliative care assessment, 300301 Cognitive functioning assessment, 294295 perceptions of current health system Colorado Foundation for Medical Care, 266 performance, 22, 24 Colorectal cancer, 116117 in performance measurement, 90, 118, Community-level performance 168 measurement, 97 performance report design, 123124 Community Medicine Associates, 150, 151, quality measurement framework, 173 161163 starter set of performance measures, Competition, 27 213214 Composite measures transitional care experiences, 262263 case study, 152 See also Patient-centered care definition, 9192 Consumer-Purchaser Disclosure Project, 25 implementation, 93 Continuity of care obstacles to development of, 9293 measures of, 90 purpose, 13, 88 palliative care assessment, 300301 rationale, 92 See also Transitions, care in scoring methodology, 9394, 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, 122123, 188189, 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 204205 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, 149150 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, 173174 Disease-specific mortality measures, 120, 121 Donabedian model for quality of care D assessment, 170172 Dyspnea assessment, 294295 Dartmouth Atlas, 232, 289 Data collection auditing of performance measurement E system, 3, 10, 43, 77 challenges for small firms, 149150 Effectiveness of care components of performance current health care system, 2122 measurement, 4243, 198199 definition, 130 consumer surveys, 45 goals, 1, 31, 172 cost of, 150, 199 starter set of performance measures, on efficiency of care, 227, 232235 208211 to improve performance measurement, Efficiency of care 198199 case study of physician performance national vs.
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From page 349... ...
INDEX 349 performance measurement, 103, 105, Episodic efficiency, 117 225230 Equitable care productive efficiency, 223 current measurement efforts, 3, 41 quality dimensions of measurement, data collection needs to assess, 13 231232 definition, 131 research needs, 116117, 230238 goals, 1, 31, 172 resource allocation model, 223 NQCB rationale, 67 resource attribution in measurement of, performance measurement goals, 96 235236 regional variation, 24 risk adjustment and, 227228, 237 research needs, 117118 starter set of performance measures, 11, role of NQCB, 78 108109 shortcomings of current health care technical efficiency, 223 system, 2, 23 Elderly, 104 Evidence-based practice Electronic health records NQCB design principles, 166167 barriers to implementation, 149 organizational characteristics and, 26 current use patterns, 2526 recommendations for NQCB, 7374 definition, 129 implementation case studies, 155, 156 157, 163164 F NQCB implementation, 1012, 7980 role in performance measurement, 167 Family care-giving, 253254 Federal Employees Health Benefits Program, 168 Electronic prescribing, 25, 106107 9, 72 Emotional functioning assessment, 294295 Fee for service definition, 129 End-of-life/palliative care, 173 bereavement assessment, 312 longitudinal measurement and, 89 care planning assessment, 296299, Food and Drug Administration, 174 Forum for Health Care Quality 307309 caregiver concerns, 311 Measurement and Reporting, 47 challenges in performance measurement, Foundation for Accountability, 84, 93, 173, 174 287, 313317 current performance measurement, 173, Funding 287, 288304 assistance to providers for starter set implementation, 12, 102 definition, 288, 315316 domains of measurement, 288 to develop national performance performance measurement rationale, measurement system, 6, 5354 financial incentives for performance 287288 quality improvement projects, 304307 measurement, 148 quality of care, 22 National Quality Forum, 49 NQCB, 9, 14, 7273, 79, 126 recommendations for measurement, 307313 research needs, 312313, 317 G site-of-death issues, 313315, 316 survival time measurement, 317 Goals for health system End-stage renal disease efficiency measurement and, 237238 mortality measurement, 120 local priorities, 10, 76 NHQR performance measures, 221 performance measure selection and, starter set of performance measures, 11, 192195 108, 221 performance measurement linkage, 3, 6 Epidemiological research, 74 progress to date, 12
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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, 138139 selective referral, 177, 194195 Hospital Standardized Mortality Rate Government Accountability Office, 10 model, 121122 Grantmakers in Health, 14, 126 Hospitals GreenField Health (Oregon) , 149, 150, access, 117 159160 acute care performance measurement, 106107 care in transitions, 90, 119 H current performance measurement programs, 40, 4546, 185, 196197 Health Insurance Portability and direct outcome measurement, 190192 Accountability Act, 80 efficiency measurement, 229230 Health maintenance organizations, 44 health care spending in, 106 Health Plan Employer Data and mortality measurement, 121122 Information Set, 100 performance incentives, 29 ambulatory care measures, 178179 public reporting system, 28 features, 44, 196197 structural measures of quality of care, limitations, 2728 185186 record review costs, 152 Hypertension, 50 starter set of performance measures, 107, 208219 Health plans I consumer decision-making, 2728 current performance measurement, 27 Indian Health Service, 9, 72 28, 196197 Infant mortality, 22, 24, 104105 obstacles to high-quality care in design Information technology of, 2830 barriers to adoption, 26 provider performance incentives, 2829, insurance payment disincentives to 41 investment in, 29 stability assessment, 214215 recent initiatives to improve quality of starter set performance measures, 11, care, 24 107108, 214215, 218219 service delivery monitoring, 31 See also Insurance shortcomings of current practice, 2526 Health Resources and Services for transitional care, 256257, 269270, Administration, 8, 7172 275 HealthPartners, Inc., 93, 152154 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, 116117 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 107108, 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, 2930 107108, 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, 116117 infant mortality, 104105 goals of national performance information technology implementation, measurement system, 84, 167 26 of outcomes, 9091, 108109, 120 palliative care, 306307 of pain control, 120 performance measurement efforts, 5253 rationale, 8990, 119 quality of care, 1 shortcomings of current system, 8788 starter set, 108109 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, 4546, 49, 50, 140141, 185, charge of Redesigning Health Insurance 230, 256 Performance Measures, Payment, and transitional care assessment, 252, 267 Performance Improvement Project, 268 1720 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, 67, 89, Program, 1720, 25, 41, 266, 275 69, 7172, 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, 140141, 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, 7576, 81 Minimum Data Set, 46, 107108
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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) , 142143 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, 4344, 51, 64, 140141, 178, measurement, 50, 178179 229230, 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, 4748 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, 262263, 265, 271272 107108 Payment incentives case study, 159 current health plan shortcomings, 2829 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, 170172 20 health care system, 27 impact of performance measurement, 7 information technology implementation, need for performance measures to 26 implement, 2, 3031 NQCB, 7879 rationale, 31 structural measures of care, 185186 strategies for health system Osteoarthritis, 50 improvement, 1, 23 Outcome and Assessment Information Set, in transitional care, 269 46, 107108 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, 5556 programs, 190192 alternatives to, 6568 disease-specific mortality, 120, 121 challenges to development and in efficiency of care measurement, 116 implementation, 42, 5354 in end-of-life/palliative care, 313315 data collection and analysis capabilities hospital-specific mortality, 121122 for, 4243 longitudinal measures, 8991 design principles, 57, 84, 166169 pain control, 120 desirable attributes, 3, 5457 process measures and, 186188, 189 as disincentive to innovation, 77 standardization, 42 evaluation of, 14, 114, 124126, 169 starter set of performance measures, 11, implementation, 30, 54, 57 108109 international comparison, 5253 structural measures, 185186 leadership needs, 6, 15, 66 in transitional care, 90, 119, 263 lessons from NQF, 49 local considerations, 10 pioneering programs, 4346 P prospects for health system without, 15, Pain management assessment, 49, 120, 290 6465, 79 293, 304, 309310 public health role, 57 Palliative care. See End-of-life/palliative care quality improvement role, 5657 Palliative Care Benchmarking, 303 rationale, 2, 3, 15, 3032, 4647, 63 Pathways to Quality Health Care reports, recent collaborative efforts, 4651 23, 1720 resistance to, 6970, 149 Patient-centered care shortcomings of current initiatives to current measurement efforts, 13, 41 develop, 36, 49, 51, 5354, 64, 68 definition, 118, 130 strategies for implementing, in health health care system goals, 1, 31, 172 care organizations, 144149 patient-level measurement, 13, 4243, See also National Quality Coordination 84, 88, 9192, 9596, 118119, 201 Board (NQCB)
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From page 354... ...
354 INDEX Performance Measurement Coordinating transitional care, 261264, 270274 Council, 49 See also Performance measurement, Performance measures national system of; Starter set of access to patient-level data, 4243 performance measures approaches to improve health care, 84 Pharmacy services 86, 8788 data management, 234235 care across settings, 8990, 95 electronic prescribing, 25, 106107 care across time, 13, 89, 90 public perception of drug costs, 24 case studies of implementation, 150164 in transitional care, 234235 chronic care, 104 Physician Consortium for Performance community-level, 97 Improvement, 50, 142143, 179 composite measures, 13, 88, 9194 Physician Practice Connections, 51 comprehensive measurement, 84, 87, 88, Pneumonia, 106 89, 95, 115119, 166 Population-based measurement, 84, 88, 91, condition-specific, 196 9496, 167 consistency in application, 3 Population-based measures, 13 criteria for selection, 98, 192196 Preferred provider organizations, 107 current leading sets, 84, 170, 178179, Prenatal health 185, 196197 performance measurement, 50, 103, definition, 130 104105 development methodology, 122123 starter set of performance measures, 206 efficiency of care, 103, 105, 116117, President's Advisory Commission on 229230 Consumer Protection and Quality in end-of-life/palliative care, 288304, 307 the Health Care Industry, 47 313 Prevention equity of care, 117118 performance measurement, 50, 103104 evaluation of, 177178 population health improvement, 94 longitudinal, 84, 8788, 8991, 116 in prenatal care, 105 117, 119120, 167 process measures of, 186188 outcome measures, 190192 role of national performance pain control, 120 measurement system, 57 patient-centered, 13, 84, 88, 9194, 95 starter set of performance measures, 204 96, 118119 Prime Care Family Practice, 151, 155157 population-based, 13, 84, 88, 91, 9496, Privacy, 27, 8081 167 Private sector research, 21 prenatal care, 104105 Process of care measurement, 186190 preventive care, 103104 in transitions, 260, 261, 262 procedure-specific, 196 Providers. See Clinicians and providers process measures, 186190 Public good, 6 rationale, 79, 177, 255256 Public reporting on performance reliability, 19201 case studies, 154 research agenda, 114122, 198201 current programs, 6, 2728, 4041 role of NQCB in developing, 7, 68 evidence of quality improvement from, scope, 12, 89 6364 shared accountability, 84, 88, 9798, format design and testing, 14, 15, 114, 122, 168169 123124 shortcomings of current set, 1213, 31 impact of performance measurement, 7 32, 41, 43, 83, 84, 8698, 99100, implementation of national system, 57 175 local considerations, 10 standardization requirements, 42, 43 national performance measurement structure measures, 185186 system and, 2, 3, 15, 3031, 57 systems-level, 13, 91, 9697, 121 rationale, 31
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From page 355... ...
INDEX 355 recommendations for Medicare, 9, 72 health care spending and, 12, 22 role of NQCB, 7, 67, 68 health plan design as obstacle to, 2830 strategies for health system impact of performance measurement, 7, improvement, 1 63 Purchasing practices NQCB impact assessment, 124126 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, 186190, 260, 261, 262 Quality improvement, 2 public reporting effects on, 6364 clinical priority areas for, 173174 role of NQCB, 7, 7475, 80 collaboratives, 1 scope of measurement, 12 consumer advocacy for, 27 structural measures, 185186, 260261 current efforts, 12, 2425, 41 in transitions, 250, 254255 definition, 131 See also Quality improvement end-of-life/palliative care, 304305 Quality of Care for Oncologic Conditions environmental barriers to, 26 and HIV, 303304 government regulation for, 30 market incentives for, 27, 30 need for performance measures for, 2, 3, R 15, 3032, 5657 obstacles to, 2 Race/ethnicity organizations, 1720 current inequities in health system, 2, 23 professional education and monitoring data collection needs, 13, 118 for, 30 treatment outcome disparities, 103104, sustaining, after performance 118 measurement implementation, 148 treatment outcome measurement, 120 149 RAND Corporation, 93, 197, 262, 303304 in transitional care, 255261, 264270 Redesigning Health Insurance Performance See also Quality of care Measures, Payment, and Performance Quality Improvement Organizations. See Improvement Project, 23, 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, 230238 current physician recognition programs, to improve performance measurement, 51 198201 current system, 2122, 2526 NQCB agenda.
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From page 356... ...
356 INDEX Research agenda for NQCB Society for Hospital Medicine, 266 components, 14, 113114 Society for Thoracic Surgeons, 190 contracting and grantmaking authority, Socioeconomic status 114 current inequities in health system, 2 efficiency of care, 116117 data collection needs, 13, 118 funding, 14 Spending goals, 7, 68, 7475, 109, 113, 115 consumer health care, 22 new measure development and current research system, 21 implementation, 114123 electronic health record implementation, participants, 1415, 126 155, 156157, 163164 performance measurement system in hospitals, 106 evaluation, 124126 patient record review costs, 152154, recommendations, 1415, 114, 126 162 Risk adjustment, 67, 77 physician performance profiling system, definition, 131 158 direct outcome measurement and, 191 quality of care and, 12, 22 192 regional variation, 2, 22 efficiency measurement and, 227228, in transitional care, 252253 237 See also Cost of care limitations of current system, 6, 67, 77, Standardization of data 99100 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 158159 70 Rural areas, 81 role of NQCB, 7879, 83 access to care in, 24, 117 Standards-setting authority of NQCB, 89, NQCB implementation, 81, 84 7172 local considerations, 10 Starter set of performance measures, 204 S 221 acute care, 11, 106107, 206207 Safety of care ambulatory care, 11, 103106, 204206 current health care system, 2122 development methodology, 84, 170, definition, 130 174175 goals, 1, 31, 172 efficiency of care, 11, 108109 recent initiatives to improve, 2425 end-stage renal disease, 11, 108 in transitions, 254255 health plans, 11, 107 Scope of performance measurement, 12 long-term care, 11, 107108 Selective referral, 177, 194195 obstacles to implementation, 84, 100102 Shared accountability, 84, 88, 9798, 122, recommendations, 1012, 100, 102 123, 168169 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, 260261 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, 149150 System-level measurement, 13, 84, 88, 91, sustaining quality improvement, 148149 9697, 121122
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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, 254255 accomplishments, 21 recommendations for performance cost of care and, 20 measurement, 270274 Time frame of measures, 89, 90 to self-care, 253 efficiency measurement, 116, 233234 significance of, for quality improvement, long-term care, 11, 90, 107108, 220 250 shortcomings of current system, 13, 89 strategies for improving measurement, Timeliness of care 274275 definition, 130 structural measures of quality of care, goals, 1, 31, 172 260261 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, 251252 Uninsured population case-mix adjustment in performance access to care, 23 measurement, 269 economic outcomes, 23 current performance measures, 261264, patterns and trends, 2, 23 280286 United Hospital Fund, 304 current quality improvement efforts, United Kingdom, 22, 52, 306 264268 University of Colorado Health Science data sources, 259 Center, 119 definition, 90, 129, 250251 U.S. Preventive Services Task Force, 161 elements of, 251 Utilization family care-giving in, 253254 end-of-life care, 314315 goals, 251 starter set of performance measures, health care setting considerations, 259 215218 260 information technology in, 269270, 275 V medical information transfer in, 235, Value-based purchasing, 41 256257 Veterans Health Administration, 9, 63, 72, patterns and trends, 253 304 performance measurement, 90, 119, Vulnerable populations, 131 255261
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