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also document the underuse of other services—the failure to provide services from which the patient would likely have benefited (Chassin and Galvin, 1998).1 Patient safety was the subject of a landmark report by the IOM (2000).

It is these and other shortcomings in quality that led the President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry to call for a national commitment to improve quality involving both the private and the public sectors and every level of the health care system (Advisory Commission on Consumer Protection and Quality in the Health Care Industry, 1998). To help guide this process and track progress, the Advisory Commission recommended that there be an annual report to the President and Congress on the nation's progress in improving health care quality. Shortly thereafter, Congress enacted the Healthcare Research and Quality Act of 1999, directing the Agency for Healthcare Research and Quality (AHRQ) to prepare an annual report on national trends in the quality of health care provided to the American people.

AHRQ contracted with the IOM to assist in the design of the new national health care quality report. The IOM Committee on the National Quality Report on Health Care Delivery was established in 1999 and was charged with laying out a vision of the National Health Care Quality Report (also referred to as the Quality Report), including both its content and its presentation. Specifically, the committee was asked to

  • identify the most important questions to answer in evaluating whether the health care delivery system is providing high-quality health care and whether quality is improving over time;

  • identify the major aspects of quality that should be reflected in the Quality Report;

  • provide examples of specific measures that might be included in the Quality Report; and

  • provide advice on the format and production of the report.

PURPOSE OF THE NATIONAL HEALTH CARE QUALITY REPORT

The National Health Care Quality Report should serve as a yardstick or barometer by which to gauge progress in improving the performance of the health care delivery system in consistently providing high-quality care. Similar tools have been applied and found useful in other areas and industries. For example, the Bureau of Labor Statistics produces economic indicators, such as the



1 For a review of more than 70 articles documenting shortcomings in quality of care see Schuster et al., 2001.



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