Problems with quality of health care in the United States earned the attention of the public with, and have steadily gained in importance since, the release of the first in a series of Institute of Medicine (IOM) reports on this topic, "To Err is Human: Building A Safer Health System," in 1999. The release of the IOM report represented a changing approach to addressing suboptimal health care quality, from one focused primarily on quality assurance to one focused on quality improvement broadly through the realignment of systems of delivering and financing care to incentivize quality of care. This issue now occupies a prominent position on the national agenda for health care reform and is the subject of considerable congressional interest. Policy makers and others have offered a wide range of policy options to improve health care quality. This report provides information on the issue of quality measurement, which serves as the basis of several of the options policy makers are offering for addressing this problem. Specifically, recently introduced health reform bills have included a strong focus on supporting and expanding a coordinated national quality measurement infrastructure. These include efforts that would broadly support the development of national priorities in the area of performance measurement; the development of new quality measures and identification of gaps in existing measures; the expansion of the endorsement process for quality measures; and the delineation of a process, in rulemaking, for selecting and implementing new quality measures for use in public health care programs. This report begins with a brief description of health care quality activity conceptually, the types of quality information that support these activities, and how quality measurement can be placed within these frameworks. It provides a discussion of the definition of quality measurement and a description of the life cycle of quality measures, including the development of quality measures (across provider types); the process of endorsement of quality measures; and the process for implementing those measures. Overviews of selected examples of implementation, including the Physician Quality Reporting Initiative (PQRI) and the Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU), are included. The report concludes with an overview of key technical and policy issues in quality measurement.
Problems with quality of health care in the United States earned the attention of the public with, and have steadily gained in importance since, the release of the first in a series of Institute of Medicine (IOM) reports on this topic, "To Err is Human: Building A Safer Health System," in 1999. The release of the IOM report represented a changing approach to addressing suboptimal health care quality, from one focused primarily on quality assurance to one focused on quality improvement broadly through the realignment of systems of delivering and financing care to incentivize quality of care. This issue now occupies a prominent position on the national agenda for health care reform and is the subject of considerable congressional interest.
Policy makers and others have offered a wide range of policy options to improve health care quality. This report provides information on the issue of quality measurement, which serves as the basis of several of the options policy makers are offering for addressing this problem. Specifically, recently introduced health reform bills have included a strong focus on supporting and expanding a coordinated national quality-measurement infrastructure. These include efforts that would broadly support the development of national priorities in the area of performance measurement; the development of new quality measures and identification of gaps in existing measures; the expansion of the endorsement process for quality measures; and the delineation of a process, in rulemaking, for selecting and implementing new quality measures for use in public health care programs.
This report begins with a brief description of health care quality activity conceptually, the types of quality information that support these activities, and how quality measurement can be placed within these frameworks. It provides a discussion of the definition of quality measurement and a description of the life cycle of quality measures, including the development of quality measures (across provider types), the process of endorsement of quality measures, and the process for implementing those measures. Overviews of selected examples of implementation, including the Physician Quality Reporting Initiative (PQRI) and the Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU), are included. The report concludes with an overview of key technical and policy issues in quality measurement.