AHRQ is already engaged in areas of research that are critical to implementation of the quality enhancement strategy recommended in this report. For example, the current efforts to better understand the information needs of various stakeholders and to develop reporting formats that respond to these needs should be expanded in scope. There are also new areas of research that should be vigorously pursued and will require additional support. These include:

  1. The development of core sets of standardized performance measures that address important health care needs and reflect efforts to overcome methodological or structural obstacles to quality oversight.

  2. The development and evaluation of specific strategies that can improve the government’s capability to leverage its purchaser, regulator, and provider roles to enhance quality.

  3. The monitoring of national progress in meeting the six national quality aims (safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity) (Institute of Medicine, 2001a).

A wealth of performance measures already exists. In some areas, the challenge is to identify the best measures to be used across all government health care programs. However, there are also gaps in the performance measurement toolbox in such areas as mental health and end-of-life care, areas in which some believe inadequate attention has been devoted to measurement development. Lastly, there are important methodological challenges to measurement that must be addressed. Following are a few research areas the committee believes merit attention:

  • Technical, organizational, and legal challenges to the assessment of quality in clinically significant areas in which existing performance measures may lack broad acceptance or appropriate data sources, such as mental illness and addiction disorder treatments.

  • Methodological and organizational challenges to performance measurement for small groups and physicians.

  • Methodological and organizational challenges to measurement of performance across different settings, types of financing and delivery arrangements, and time, especially for chronic conditions and overall health status.

  • Development and evaluation of the impact of alternative payment models and specific financial incentives on quality

  • Development of mechanisms for useful public access to comparative quality information.

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