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The Ist Annual Crossing the Quality Chasm Summit: A Focus on Communities
Overall, the participants view measurement as crucial to accelerating performance improvement in health care. Four key strategies emerged from this session: (1) integrate measurement into the delivery of care to benefit the patient whose care is measured, (2) improve information and communications technology (ICT) infrastructure to reduce the burden of data collection, (3) focus on longitudinal change in performance and patient-centered outcomes in addition to point-in-time measures, and (4) improve public reporting by effectively disseminating results to diverse audiences.
Integrate Measurement into the Delivery of Care
The underlying principle behind this strategy is that measurement should be integrated into routine clinical practice, so that the process of providing care also enables measurement to occur. Decreasing the burden of measurement and increasing the likelihood of data collection makes it possible to determine more accurately the quality of care being delivered. Once the necessary data are available, health care delivery systems can develop creative solutions to address suboptimal performance—thus continually improving the process of care.
In addition to posing a minimal data collection burden, performance measurement and reporting cannot be overly time-consuming or perceived as punitive. Moreover, as noted throughout the condition-specific working group sessions, national consensus on a core set of performance measures should simplify and bolster compliance with data collection by eliminating the collection of multiple conflicting measures collected against competing or conflicting standards. It was suggested that this common set of measures would include assessment of success in meeting the Quality Chasm’s six aims for care—safe, effective, patient-centered, timely, efficient, and equitable—and do so in the most parsimonious manner possible so as to not be overwhelming (IOM, 2001). These key measures should be reviewed by professional societies and made readily available to purchasers and consumers.
“Institutional survival is not an aim of American health care. Patient well-being is the aim of American health care. Endorse the aims (IOM six aims) for improvement in measurable terms, and link it to measurement. If you don’t know how you are doing you can’t get better.”
—Don Berwick, summit keynote speaker
The Washington State Diabetes Collaborative—one of the 15 community participants at the summit—candidly shared with the participants in the measurement session some lessons learned from that initiative regarding the need for standardized data collection of a discrete set of measures. See Box 2-1 for a brief overview of this ground-breaking state-level project.