tion by the National Committee for Quality Assurance includes measures related to how well a health plan cares for people when they have a chronic illness in such areas as cardiovascular disease, cancer, asthma, pneumonia and influenza, and diabetes (National Committee for Quality Assurance, 1999). Peer Review Organizations focus their national quality improvement efforts on six clinical priority areas: acute myocardial infarction, breast cancer, diabetes, heart failure, pneumonia, and stroke (Health Care Financing Administration, 2000). Finally, the National Quality Forum is developing a comprehensive quality measurement and reporting strategy that will address priorities for quality measurement that are consistent with the national aims for quality improvement in health care set forth in this report (National Quality Forum for Health Care Quality Measurement and Reporting, 2000).
Various criteria can be used to identify the priority conditions. Two IOM committees have suggested criteria for setting priorities among conditions: one committee focused on how to set priorities for guideline development, the other on how to set priorities for technology assessment. The common criteria from both processes included prevalence, burden of illness, cost, variability in practice, and the potential to improve outcomes or reduce costs (Institute of Medicine, 1992, 1995).
As noted earlier, this committee suggests starting with the priority conditions identified in the MEPS. Some are long-term life-threatening conditions, such as cancer, diabetes, emphysema, high cholesterol, HIV/AIDS, hypertension, ischemic heart disease, and stroke. Others, such as arthritis, asthma, gall bladder disease, stomach ulcers, and back problems of any kind, are categorized as chronic manageable conditions. The list also includes Alzheimer’s disease, depression, and anxiety disorders. MEPS obtains a larger sample size for seven of the conditions—hypertension, ischemic heart disease, asthma, diabetes, stroke, emphysema, and arthritis—to make population estimates. Although other sources are also available, the advantage of starting with the MEPS listing is its representative population sample, as opposed to claims data that rely on services having been used.
The health care system in the United States needs significant redesign. Given the magnitude of the change required, the innovation fund recommended earlier is needed to seed projects that can help apply the concepts described in this report. A Health Care Quality Innovation Fund should finance the demonstration