rates. Syntheses of the evidence base and the development of practice guidelines should contribute to more valid and meaningful quality measurement and reporting.
As systematic reviews, development of practice guidelines, and efforts to disseminate evidence focus increasingly on priority conditions—a unit of analysis that is meaningful to patients and clinicians—so, too, must accountability processes. To date, efforts to make comparative quality data available in the public domain have focused on types of health care organizations, for the most part health plans and hospitals, and, as noted above, measurement of a limited number of discrete quality indicators for these organizations. Numerous efforts are under way, however, to develop comprehensive measurement sets for various conditions and quality reporting mechanisms. These include the efforts of the Foundation for Accountability, the Health Care Financing Administration’s peer review organizations, and a variety of collaborations involving leading medical associations and accrediting bodies.
The Foundation for Accountability (2000b) has developed condition-specific measurement guides related to a number of common conditions: adult asthma, alcohol misuse, breast cancer, diabetes, health status under age 65, and major depressive disorders. The Foundation continues to work on child and adolescent health, coronary heart disease, end of life, and HIV/AIDS. In addition, it has created FACCT|ONE, a survey tool designed to gather information directly from patients about important aspects of their health care (Foundation for Accountability, 2000a). The first phase of the survey addresses quality of care for people living with the chronic illnesses of asthma, diabetes, and coronary artery disease. It assesses performance related to patient education and knowledge, obtaining of essential treatments, access, involvement in care decisions, communication with providers, patient self-management behaviors, coping, symptom control, maintenance of regular activities, and functional status.
Since 1992, the Health Care Financing Administration, through its Peer Review Organizations, has been developing core sets of performance measures for a number of common conditions, including acute myocardial infarction, heart failure, stroke, pneumonia, breast cancer, and diabetes (Health Care Financing Administration, 2000). Comparative performance data for Medicare fee-for-service beneficiaries by state were recently released for each of these conditions (Jencks et al., 2000). Quality-of-care measures for beneficiaries experiencing acute myocardial infarction have been piloted in four states as part of the Cooperative Cardiovascular Project (Ellerbeck et al., 1995; Marciniak et al., 1998).
The Diabetes Quality Improvement Project, a collaborative quality measurement effort involving the American Diabetes Association, the Foundation for Accountability, the Health Care Financing Administration, the National Committee for Quality Assurance, the American Academy of Physicians, the American College of Physicians, and the Veterans Administration, has been under way for several years. The project has identified seven accountability measures (i.e.,