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APPENDIX A

Workshop: Envisioning a National Quality Report on Health Care

PURPOSE AND STRUCTURE OF THE WORKSHOP

The general purpose of the workshop was to provide the Institute of Medicine Committee on the National Quality Report on Health Care Delivery with practical, state-of-the-art information on the definition and reporting of national indicators of health care quality.

The workshop involved more than 40 participants and was open to the public. The topics were organized in three parts: (1) Lessons to be Learned from Other Experiences; (2) Measuring the Dimensions of Health Care Quality; and, (3) Technical, Data, and Policy Issues.

Presenters were asked to focus on the practical or applied, rather than the theoretical, aspects of their subject. They were also asked to give their opinion regarding the proposed framework for the National Health Care Quality Report as it referred to the subject they are addressing. Those presenting on specific quality measures were asked to present evidence on why the measures should be included in the Quality Report and to comment on available data sources or data needs for implementing the quality measures proposed.

ISSUES ADDRESSED AT THE WORKSHOP

  • The feasibility of measuring patient centeredness, safety, effectiveness, and efficiency as dimensions of quality of care.

  • The availability and appropriateness of public and private data sources for national indicators of quality of care.



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Page 159 APPENDIX A Workshop: Envisioning a National Quality Report on Health Care PURPOSE AND STRUCTURE OF THE WORKSHOP The general purpose of the workshop was to provide the Institute of Medicine Committee on the National Quality Report on Health Care Delivery with practical, state-of-the-art information on the definition and reporting of national indicators of health care quality. The workshop involved more than 40 participants and was open to the public. The topics were organized in three parts: (1) Lessons to be Learned from Other Experiences; (2) Measuring the Dimensions of Health Care Quality; and, (3) Technical, Data, and Policy Issues. Presenters were asked to focus on the practical or applied, rather than the theoretical, aspects of their subject. They were also asked to give their opinion regarding the proposed framework for the National Health Care Quality Report as it referred to the subject they are addressing. Those presenting on specific quality measures were asked to present evidence on why the measures should be included in the Quality Report and to comment on available data sources or data needs for implementing the quality measures proposed. ISSUES ADDRESSED AT THE WORKSHOP The feasibility of measuring patient centeredness, safety, effectiveness, and efficiency as dimensions of quality of care. The availability and appropriateness of public and private data sources for national indicators of quality of care.

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Page 160 The feasibility of translating experiences from other sectors and countries to measure quality of health care in the United States. The need for specific measures of quality for particular populations and tracking disparities in health care quality. WORKSHOP AGENDA May 22–23, 2000 Holiday Inn Georgetown—Mirage I Conference Room 2101 Wisconsin Avenue, N.W., Washington, D.C. Monday, May 22, 2000 9:00 a.m.–9:05 a.m. Welcome William L. Roper, M.D., M.P.H. Chair, IOM Committee on the National Quality Report on Health Care Delivery 9:05 a.m.–9:15 a.m. Introduction to the Workshop Mark Smith, M.D., M.B.A. Member, IOM Committee SESSION 1: Quality Indicators in Other Sectors and Other Countries: Issues of Measurement, Presentation, Process, and Accountability 9:15 a.m.–9:30 a.m. Measuring Consumer Satisfaction with Quality Across Industries—The American Customer Satisfaction Index Claes Fornell, Ph.D. University of Michigan School of Business Administration 9:30 a.m.–9:45 a.m. Indicators of Educational Quality—The National Education Report Card (NAEP) Peggy Carr, Ph.D. National Center for Education Statistics 9:45 a.m.–10:00 a.m. International Experiences in the Definition of National Indicators of Health Care Quality R. Heather Palmer, M.B., B.Ch., S.M. Harvard School of Public Health

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Page 161 10:00 a.m.–10:30 a.m. Discussion: Lessons for the Designers of the National Quality Report on Health Care Moderator: Michael Millenson William M. Mercer, Inc. 10:30 a.m.–10:45 a.m. Break SESSION 2: Measuring Health Care Safety for the National Health Care Quality Report 10:45 a.m.–11:00 a.m. Update on Federal Initiatives on Error Measures and Databases Nancy Foster, Ph.D. Gregg Meyer, M.D., M.Sc. Agency for Healthcare Research and Quality 11:00 a.m.–11:15 a.m. Assessing and Reducing Errors in Health Care: The Purchaser Perspective Suzanne Delbanco, Ph.D. Leapfrog Group 11:15 a.m.–11:30 a.m. Using Information Technology to Ensure and Assess Safety in Health Care David Bates, M.D., M.Sc. Harvard Medical School SESSION 3: Approaches to Measuring the Efficiency of Health Care for the National Health Care Quality Report 11:30 a.m.–11:45 a.m. Efficiency, Productivity in Medical Care, and Medical Cost Increases Jack Triplett, Ph.D. The Brookings Institution 11:45 a.m.–12:15 p.m. Potential Measures of Efficiency of Health Care Mark McClellan, M.D., Ph.D. Stanford University Discussant: José Escarce, M.D., Ph.D. IOM Committee

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Page 162 12:15 p.m.–12:45 p.m. Discussion: Measuring Safety and Efficiency for the National Quality Report Moderator: John Ware, Jr., Ph.D. QualityMetric Inc. 12:45 p.m.–1:45 p.m. Lunch SESSION 4: Measuring Effectiveness and Appropriateness of Care for the National Health Care Quality Report 1:45 p.m.–2:00 p.m. Measuring the Appropriateness of Nursing Care Ora Strickland, Ph.D., R.N., F.A.A.N. Emory University School of Nursing 2:00 p.m.–2:15 p.m. Considerations on the Use of Health Outcomes as Measures of Effectiveness John Ware, Jr., Ph.D. QualityMetric Inc. 2:15 p.m.–2:45 p.m. Potential Measures of Effectiveness and Appropriateness of Health Care for the National Health Care Quality Report Elizabeth McGlynn, Ph.D. Robert Brook, M.D., Sc.D. RAND Discussant: Sheldon Greenfield, IOM Committee SESSION 5: Measuring Patient Centeredness for the National Health Care Quality Report 2:45 p.m.–3:00 p.m. Measuring the Patient's Role in Collaborative Chronic Disease Care and Its Link to Quality of Care and Outcomes Jessie Gruman, Ph.D. Center for the Advancement of Health 3:00 p.m.–3:15 p.m. Measuring the Quality of Interpersonal Care and Patient Involvement in Care Sherrie Kaplan, Ph.D., M.P.H. Primary Care Outcomes Research Institute, New England Medical Center

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Page 163 3:15 p.m.–3:30 p.m. What Lies Ahead? Quality Measurement and the Future Role of the Consumer in Care Michael Millenson William M. Mercer, Inc. 3:30 p.m.–4:00 p.m. Developing Potential Measures of Patient Centeredness for the National Health Care Quality Report Christina Bethell, Ph.D., M.B.A., M.P.H. Foundation for Accountability Discussant: Judith Hibbard, Dr.P.H., IOM Committee 4:00 p.m.–4:15 p.m. Break SESSION 6: General Discussion on Measures for the National Health Care Quality Report 4:15 p.m.–5:30 p.m. Discussion Moderator: Arnold Epstein, M.D., M.A. IOM Committee 5:30 p.m. Adjourn Tuesday, May 23, 2000 SESSION 7: Issues to Be Considered in Selecting and Defining Measures for the National Health Care Quality Report 9:00 a.m.–9:15 a.m. Defining Indicators and Indices to Track the U.S. Health Care System Robert Rubin, M.D. The Lewin Group 9:15 a.m.–9:30 a.m. Quality of Care Assessments: New Paradigms Barbara Starfield, M.D., M.P.H. Johns Hopkins University 9:30 a.m.–9:45 a.m. Variability as a Measure of Quality: The Influence of Patient Preferences and Provider Practice John Wennberg, M.D., M.P.H. Dartmouth Medical School

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Page 164 9:45 a.m.–10:00 a.m. Monitoring Racial, Ethnic, and Socioeconomic Disparities in Health Care: Conceptual Issues and Practical Considerations David Williams, Ph.D. University of Michigan SESSION 8: Available and Needed Data for the National Health Care Quality Report 10:00 a.m.–10:15 a.m. Public Sources of Data and Possible Indicators for the National Health Care Quality Report Irma Arispe, Ph.D. National Center for Health Statistics 10:15 a.m.–10:45 a.m. Potential Quality Indicators Using Private Data Sources and Future Data Needs for the National Health Care Quality Report Marsha Gold, Sc.D. Mathematica Policy Research Discussant: William Stead, IOM Committee SESSION 9: Technical and Data-Related Barriers to Producing a National Health Care Quality Report 10:45 a.m.–11:30 a.m. Discussion Moderator: R. Heather Palmer, M.B., B.Ch., S.M. Harvard School of Public Health 11:30 a.m.–11:45 a.m. Break SESSION 10: Roundtable—What Do Policy Makers Want from the National Health Care Quality Report? Moderator: Robert Rubin, M.D., The Lewin Group 11:45 a.m.–12:30 p.m. Congress Cybele Bjorklund, M.P.H. Senate Committee on Health, Education, Labor and Pensions   Jason Lee, Ph.D. House Committee on Commerce

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Page 165   The States Lee Partridge American Public Human Services Association John Colmers, M.P.H. Maryland Health Care Commission   Other Policy Makers: Insurers Donald Young, M.D. Health Insurance Association of America 12:30 p.m.–1:00 p.m. Discussion: How to Produce a Report Useful to Policy Makers and Understandable to the Public 1:00 p.m.–1:15 p.m. Closing Comments Mark Smith, M.D., M.B.A., IOM Committee 1:15 p.m. Adjourn WORKSHOP SPEAKERS IRMA E. ARISPE, Associate Director for Science, Division of Health Care Statistics, National Center for Health Care Statistics, Hyattsville, Maryland DAVID W. BATES, Chief, Division of General Medicine, Brigham and Women's Hospital, Boston, Massachusetts CHRISTINA BETHELL, Senior Vice President, Research and Policy, Foundation for Accountability (FACCT), Portland, Oregon CYBELLE BJORKLUND, Deputy Staff Director, Senate Committee on Health, Education, Labor and Pensions, Washington, D.C. ROBERT H. BROOK, Vice President and Director, RAND Health and Corporate Fellow, The RAND Corporation, Santa Monica, California PEGGY G. CARR, Associate Commissioner, Assessment Division, National Center for Education Statistics, Washington, D.C. SUZANNE F. DELBANCO, Executive Director, Leapfrog Group, Washington, D.C. CLAES G. FORNELL, Donald C. Cook Professor of Business Administration and Director, National Quality Research Center, University of Michigan School of Business Administration, Ann Arbor, Michigan NANCY FOSTER, Agency for Healthcare Research and Quality, Rockville, Maryland MARSHA GOLD, Senior Fellow, Mathematica Policy Research, Inc., Washington, D.C. JESSIE GRUMAN, Executive Director, Center for the Advancement of Health, Washington, D.C.

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Page 166 SHERRIE H. KAPLAN, Co-director, Primary Care Outcomes Research Institute, Tufts University School of Medicine, New England Medical Center, Boston, Massachusetts JASON LEE, Health Policy Counsel, U.S. House of Representatives, Committee on Commerce, Washington, D.C. MARK B. McCLELLAN, Assistant Professor, Department of Economics, Stanford University, Stanford, California ELIZABETH A. McGLYNN, Senior Researcher, The RAND Corporation, Santa Monica, California GREGG MEYER, Director, Center for Quality Measurement and Improvement, Agency for Healthcare Research and Quality, Rockville, Maryland MICHAEL L. MILLENSON, Principal, William M. Mercer, Inc., Chicago, Illinois R. HEATHER PALMER, Director, Center for Quality of Care Research and Education, Harvard School of Public Health, Boston, Massachusetts LEE PARTRIDGE, American Public Human Services Association, Washington, D.C. ROBERT J. RUBIN, President, The Lewin Group, Falls Church, Virginia BARBARA STARFIELD, University Distinguished Professor, The Johns Hopkins University, Baltimore, Maryland ORA STRICKLAND, Professor, Neil Hodgson Woodruff School of Nursing, and Director, Research on Special Populations of Veterans, Atlanta VA Medical Center, Atlanta, Georgia JACK E. TRIPLETT, Visiting Fellow, Brookings Institution, Washington, D.C. JOHN E. WARE, JR., President and Chief Scientific Officer, QualityMetric, Inc., Lincoln, Rhode Island JOHN E. WENNBERG, Director, Center for Evaluative Clinical Sciences, Dartmouth Medical School, Hanover, New Hampshire DAVID R. WILLIAMS, Senior Research Scientist, Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan DONALD YOUNG, Chief Operating Officer and Medical Director, Health Insurance Association of America, Washington, D.C.