Pathways to Quality Health Care

PERFORMANCE MEASUREMENT

Accelerating Improvement

Committee on Redesigning Health Insurance Performance Measures, Payment, and Performance Improvement Programs

Board on Health Care Services

INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS
Washington, D.C.
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Performance Measurement: Accelerating Improvement Pathways to Quality Health Care PERFORMANCE MEASUREMENT Accelerating Improvement Committee on Redesigning Health Insurance Performance Measures, Payment, and Performance Improvement Programs Board on Health Care Services INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES THE NATIONAL ACADEMIES PRESS Washington, D.C. www.nap.edu

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Performance Measurement: Accelerating Improvement THE NATIONAL ACADEMIES PRESS 500 Fifth Street, N.W. Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This study was supported by Contract No. HHSM-500-2004-00005C between the National Academy of Sciences and the U.S. Department of Health and Human Services through the Centers for Medicare and Medicaid Services. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project. Library of Congress Cataloging-in-Publication Data Performance measurement : accelerating improvement / Committee on Redesigning Health Insurance Performance Measures, Payment, and Performance Improvement Programs, Board on Health Care Services. p. ; cm.—(Pathways to quality health care) Includes bibiographical references. ISBN 0-309-10007-0 (hardback) 1. Medical care—United States—Quality control. 2. Medical care—Standards—United States. 3. Performance—Measurement. I. Institute of Medicine (U.S.). Committee on Redesigning Health Insurance Performance Measures, Payment, and Performance Improvement Programs. II. Series. [DNLM: 1. Quality Assurance, Health Care—methods—United States. 2. Quality of Health Care—standards—United States. W 84 AA1 P32 2006] RA399.A3P44 2006 362.1068—dc22 2005037405 Additional copies of this report are available from the National Academies Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2006 by the National Academy of Sciences. All rights reserved. Printed in the United States of America. The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museum in Berlin.

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Performance Measurement: Accelerating Improvement “Knowing is not enough; we must apply. Willing is not enough; we must do.” —Goethe INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES Advising the Nation. Improving Health.

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Performance Measurement: Accelerating Improvement THE NATIONAL ACADEMIES Advisers to the Nation on Science, Engineering, and Medicine The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Wm. A. Wulf are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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Performance Measurement: Accelerating Improvement COMMITTEE ON REDESIGNING HEALTH INSURANCE PERFORMANCE MEASURES, PAYMENT, AND PERFORMANCE IMPROVEMENT PROGRAMS STEVEN A. SCHROEDER (Chair), Distinguished Professor of Health and Health Care, University of California, San Francisco, CA BOBBIE BERKOWITZ, Alumni Endowed Professor of Nursing, Psychosocial and Community Health, University of Washington, Seattle, WA DONALD M. BERWICK, President and Chief Executive Officer, Institute for Healthcare Improvement, Cambridge, MA BRUCE E. BRADLEY, Director Health Plan Strategy and Public Policy Health Care Initiatives, General Motors Corporation, Pontiac, MI JANET M. CORRIGAN,* President and Chief Executive Officer, National Committee for Quality Health Care, Washington, DC KAREN DAVIS, President, Commonwealth Fund, New York, NY NANCY-ANN MIN DEPARLE, Senior Advisor, JP Morgan Partners, LLC, Washington, DC ELLIOTT S. FISHER, Professor of Medicine and Community Family Medicine, Dartmouth Medical School, Hanover, NH RICHARD G. FRANK, Margaret T. Morris Professor of Health Economics, Harvard Medical School, Boston, MA ROBERT S. GALVIN, Corporate Health and Medical Programs, General Electric Company, Fairfield, CT DAVID H. GUSTAFSON, Research Professor of Industrial Engineering, University of Wisconsin, Madison, WI MARY ANNE KODA-KIMBLE, Professor and Dean, School of Pharmacy, University of California, San Francisco, CA ALAN R. NELSON, Special Advisor to the Executive Vice President, American College of Physicians, Fairfax, VA NORMAN C. PAYSON, President, NCP, Inc., Concord, NH WILLIAM A. PECK, Director, Center for Health Policy, Washington University School of Medicine, St. Louis, MO NEIL R. POWE, Professor of Medicine, Epidemiology and Health Policy, Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, MD CHRISTOPHER QUERAM, Chief Executive Officer, Employer Health Care Alliance Cooperative—The Alliance, Madison, WI ROBERT D. REISCHAUER, President, The Urban Institute, Washington, DC WILLIAM C. RICHARDSON, Former President, W.K. Kellogg Foundation, Battle Creek, MI *   Dr. Corrigan was appointed to the Committee on June 1, 2005.

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Performance Measurement: Accelerating Improvement CHERYL M. SCOTT, President Emerita, Group Health Cooperative, Seattle, WA STEPHEN M. SHORTELL, Blue Cross of California Distinguished Professor of Health Policy and Management and Dean, School of Public Health, University of California, Berkeley, CA SAMUEL O. THIER, Professor of Medicine and Professor of Health Care Policy, Harvard Medical School and Massachusetts General Hospital, Boston, MA GAIL R. WILENSKY, Senior Fellow, Project HOPE, Bethesda, MD Study Staff JANET CORRIGAN, Project Director1 ROSEMARY A. CHALK, Project Director2 KAREN ADAMS, Senior Program Officer, Lead Staff for the Subcommittee on Performance Measurement Evaluation DIANNE MILLER WOLMAN, Senior Program Officer, Lead Staff for the Subcommittee on Quality Improvement Organizations Evaluation CONTESSA FINCHER, Program Officer3 TRACY HARRIS, Program Officer SAMANTHA CHAO, Senior Health Policy Associate DANITZA VALDIVIA, Program Associate MICHELLE BAZEMORE, Senior Program Assistant Editorial Consultants RONA BRIERE, Briere Associates, Inc. ALISA DECATUR, Briere Associates, Inc. 1   Served through May 2005. 2   Beginning May 2005. 3   Served through July 2005.

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Performance Measurement: Accelerating Improvement Reviewers This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s (NRC’s) Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: KATHLEEN O. ANGEL, Director of Global Benefits and International Compensation, Dell Computer Corporation, Round Rock, TX ELIZABETH H. BRADLEY, Associate Professor of Public Health and Director of the Health Management Program in the Division of Health Policy and Administration, Yale School of Medicine, New Haven, CT LINDA BURNES-BOLTON, Vice President and Chief Nursing Officer, Cedars-Sinai Medical Center, Los Angeles, CA ROBERT GRAHAM, Professor of Family Medicine and a Robert and Myfanwy Smith Chair, University of Cincinnati College of Medicine, OH STUART GUTERMAN, Senior Program Director of Medicare Future, Commonwealth Fund, New York, NY

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Performance Measurement: Accelerating Improvement DAVID A. KNAPP, Dean of the School of Pharmacy, University of Maryland, Baltimore, MD STEVE LIPSTEIN, Chief Executive Officer, Barnes Jewish HealthCare, St. Louis, MO HAROLD S. LUFT, Director and Caldwell B. Esselstyn Professor of Health Policy and Health Economics, The Institute of Health Policy Studies, University of California at San Francisco, San Francisco, CA RICARDO MARTINEZ, Executive Vice President of Medical Affairs, The Schumacher Group, Kennesaw, GA WALTER ORENSTEIN, Director of Vaccine Policy and Development and Associate Professor, Emory University School of Medicine, Atlanta, GA L. GREGORY PAWLSON, Executive Vice President, National Committee on Quality Assurance, Washington, DC PAMELA B. PEELE, Associate Professor and Vice Chair of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, PA SARA ROSENBAUM, Chair of the Department of Health Policy, George Washington University, Washington, DC TIM SIZE, Executive Director, Rural Wisconsin Health Cooperative, Sauk City, WI SHOSHANNA SOFAER, Robert P. Luciano Professor of Health Care Policy, School of Public Affairs, Baruch College, New York, NY ALAN M. ZASLAVSKY, Professor of Statistics, Department of Health Care Policy, Harvard Medical School, Boston, MA Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by coordinator DONALD M. STEINWACHS, Ph.D., Professor and Chair, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, and monitor HAROLD C. SOX, M.D., M.A.C.P., Editor, Annals of Internal Medicine, Philadelphia, PA. Appointed by the NRC, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

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Performance Measurement: Accelerating Improvement Preface Performance Measurement: Accelerating Improvement is the first in a new series of reports by the Institute of Medicine (IOM), representing the latest phase of the ongoing IOM effort on health care quality. This report introduces a framework and implementation strategy for translating public and professional concerns about performance and accountability into measures of health care quality. In so doing, it builds upon central themes articulated in earlier IOM reports, including To Err Is Human: Building a Safer Health System and Crossing the Quality Chasm: A New Health System for the 21st Century. In particular, this report addresses one aspect of an overall strategy for implementing the six aims of the health care system articulated in the Quality Chasm report: health care should be safe, effective, patient-centered, timely, efficient, and equitable. In its deliberations, the IOM Committee on Redesigning Health Insurance Performance Measures, Payment, and Performance Improvement Programs was struck by the energy and thoughtfulness displayed in multiple efforts to create health care quality improvement measures among public and private stakeholders and throughout the medical profession. These efforts represent important contributions to the development of new standards of accountability. However, the lack of connections and conceptual links among the performance measures put forth by different groups has created an administrative burden for providers, and is a significant barrier to moving the quality initiative forward to a new stage of development. The time is ripe, therefore, for an informed national effort to standardize measures that can lay the foundation for a health care incentive system designed to reward the achievement of the six aims articulated in the Qual-

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Performance Measurement: Accelerating Improvement ity Chasm report. Such measures can be used for many purposes: data collection, public reports, provider awareness, quality improvement, purchaser benchmarks, and payment incentives. This report offers a set of measures to address these multiple goals. Some are ready to use now; others will require further research and dedicated effort in areas that are more difficult to address. Some measures will apply to multiple purposes and health care settings; others will require more selectivity and consideration. An oversight and coordinating system will be necessary to clarify the national goals for performance measurement, highlight ready-to-use measures, establish benchmarks, and allocate resources for the development of more robust measures that will be ready to use at a future time. The IOM’s health care quality reports have consistently sounded the call for evidence-based approaches and strategies formed by consensus that can change the health care environment and improve health outcomes for all. It is the committee’s hope and expectation that this new series of reports will contribute to the development of consensus throughout the health care system regarding the basic performance measures, payment incentives, and quality improvement strategies that should be instituted now and in the future. The series builds on common ground but also offers a new vision in articulating where we must go and the pathways that offer the greatest promise in advancing the quality agenda. This report is directed toward all concerned with improving the quality and performance of the nation’s health care system in its multiple dimensions and in both the public and private sectors. The committee particularly encourages the U.S. Department of Health and Human Services to lay the groundwork for this effort within the Medicare system, setting an example through federal leadership that can strengthen the quality improvement process throughout the national health care environment. We recognize that such fundamental change in the health care system will not happen by itself. Therefore, we articulate the need for renewed effort, expanded resources, and an oversight and coordinating effort to guide the next stage of development. Creative partnerships will be necessary between the public and the private sectors, between Congress and health care leaders, between purchasers and providers, and between consumers and oversight groups. There will be a need for much good will to overcome personal interests in achieving shared goals that can serve the interests of multiple stakeholders and the common good. As chairman of the committee, I thank the committee members and staff and the Subcommittee on Performance Measures for their generous contributions. They shared their time, their talent, and their expertise during many long sessions and deliberations. Our subcommittee cochairs, Don Berwick and Elliott Fisher, and IOM senior program officer Karen Adams,

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Performance Measurement: Accelerating Improvement who directed this effort, deserve special recognition. It is my hope that this report reflects the integration of many voices that together can inform and advance the policy agenda to achieve the quality health care system envisioned in the Quality Chasm report. Steven A. Schroeder, M.D. Chairman November 2005

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Performance Measurement: Accelerating Improvement hance the multiple efforts now under way. Future reports will assess performance improvement initiatives in other arenas (with a special focus on Medicare’s quality improvement organization programs) and formulate criteria that can guide payment strategies. We anticipate that the Pathways series will complement and extend the earlier Quality Chasm series of IOM reports. In short, we are moving from the “what” of quality improvement to the “how.” This series is part of a larger effort at the IOM to remedy flaws in our health care system, enhance the quality of services, reduce waste and inefficiency, promote patient safety and beneficiary protections, ensure that public and private purchasers obtain value for their dollars, and foster equity. These are the right goals to pursue, and we cannot wait any longer to undertake that crucial effort. Harvey V. Fineberg, M.D., Ph.D. President, Institute of Medicine October 2005

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Performance Measurement: Accelerating Improvement Acknowledgments Performance Measurement: Accelerating Improvement benefited from the contributions of many individuals. The committee takes this opportunity to recognize those who so generously gave their time and expertise to inform its deliberations. The committee wishes to acknowledge the members of the Subcommittee on Performance Measurement and the outstanding leadership of cochairs Don Berwick (Institute for Healthcare Improvement) and Elliott S. Fisher (Dartmouth Medical School). Subcommittee members included Patricia Gabow (Denver Health and Hospital Authority), Lillee Gelinas (VHA, Inc.), Margarita Hurtado (American Institutes for Research), George Isham (HealthPartners, Inc.), Brent James (Intermountain Health Care), Arthur Levin (Center for Medical Consumers), Glen Mays (University of Arkansas for Medical Sciences), Elizabeth McGlynn (RAND Corporation), Arnold Milstein (Pacific Business Group on Health), Sharon-Lise Normand (Harvard Medical School), Barbara Paul (Beverly Enterprises, Inc.), Samuel Thier (Harvard Medical School and Massachusetts General Hospital), and Paul Wallace (Kaiser Permanente Care Management Institute). The committee commissioned several papers to provide background information for its deliberations and to synthesize the evidence on particular issues. These papers are included as appendixes to this report. We thank John D. Birkmeyer, Eve A. Kerr, and Justin B. Dimick of the University of Michigan for their paper on “Improving the Quality of Quality Improvement”; Eric M. Coleman of the University of Colorado Health Science Center for his paper on “Transitional Care Performance Measurement”; Kyle L. Grazier of the University of Michigan, School of Public Health, for

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Performance Measurement: Accelerating Improvement her paper on “Efficiency/Value Based Measures for Services, Defined Populations, Acute Episodes and Chronic Conditions”; and Sydney Dy of the Johns Hopkins Bloomberg School of Public Health and Joanne Lynn of the Washington Home for Palliative Care Studies for their paper on “Palliative Care/End of Life Measures.” We also wish to acknowledge the input received from several experts who participated in the Performance Measurement Subcommittee Workshop held on December 1, 2004, in Washington, DC: R. Adams Dudley of the University of California, San Francisco; Robert Krughoff of the Center for the Study of Services; Tom Lee of Partners HealthCare System, Inc.; Mary Naylor of the University of Pennsylvania School of Nursing; Judy Hibbard of the University of Oregon; Al Mulley of the Massachusetts General Hospital; Dana Gelb Safran of the Health Institute at Tufts-New England Medical Center; Gail Amundson of HealthPartners, Inc.; Eugene C. Nelson of Dartmouth Medical Center; David Wennberg of the Health Dialog Data Service; and Mark E. Miller and Karen Milgate of MedPAC. The committee appreciates the valuable feedback received from the case study participants: Community Medical Associates, San Antonio, Texas, GreenfieldHealth, Portland, Oregon; HealthPartners, Inc., Minneapolis, Minnesota; North Texas Medical Group, Plano, Texas; Primary Care Family Practice, Clinton, Oklahoma; Rochester Individual Practice Association, Rochester, New York; and Internal Medicine Solo Practice, Fort Walton Beach, Florida. The committee would also like to acknowledge organizations that provided us feedback on various topics: Agency for Healthcare Research and Quality; Ambulatory care Quality Alliance; Centers for Medicare and Medicaid Services; Denver Health and Hospital Authority; Hospital Quality Alliance; Joint Commission on Accreditation of Healthcare Organizations; Kaiser Permanente Care Management Institute; Leapfrog Group; National Committee for Quality Assurance; National Quality Forum; Partners Health Care; Physician Consortium of the American Medical Association; and VHA, Inc. The committee would also like to thank Tyjen Tsai and Shari Erickson of the Institute of Medicine staff for their additional support towards the completion of this report. Finally, the committee gratefully acknowledges the U.S. Department of Health and Human Services through the Centers for Medicare and Medicaid Services, whose funding supported this congressionally mandated study.

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Performance Measurement: Accelerating Improvement Contents     EXECUTIVE SUMMARY   1      The Redesigning Health Insurance Project,   2      Need for a National System for Performance Measurement and Reporting,   3      Recommendations for Achieving a National Performance Measurement and Reporting System,   6      A Recommended Starter Set of Performance Measures,   10      A Recommended Research Agenda,   14      Consequences of Inaction,   15      References,   15 1   INTRODUCTION   17      The Current Health Care Landscape,   21      Need to Accelerate the Pace of Improvement,   24      The Health Care Enterprise,   27      The Need for a National System for Performance Measurement and Reporting,   30      Scope and Organization of This Report,   32      References,   33 2   CURRENT AND FUTURE STATE OF PERFORMANCE MEASUREMENT AND REPORTING   40      Performance Measurement and Reporting: What Do We Mean?,   42

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Performance Measurement: Accelerating Improvement      Recent Efforts to Promote Standardized Performance Measurement,   43      Performance Measurement Efforts in Other Countries,   52      Limitations of Current Performance Measurement Efforts,   53      Attributes of a Well-Functioning System for Performance Measurement and Reporting,   54      Next Steps,   57      References,   59 3   ACHIEVING A NATIONAL SYSTEM FOR PERFORMANCE MEASUREMENT AND REPORTING   63      Alternatives to Achieving a National System for Performance Measurement and Reporting,   63      Assessment of Alternatives,   65      Essential Attributes of the NQCB,   69      Funding for the NQCB,   73      Guidelines for the Design and Operation of the NQCB,   73      Potential Concerns: The Rationale for the NQCB,   78      References,   81 4   MOVING FORWARD: WHAT SHOULD BE MEASURED?   83      Approach,   84      Gaps in Current Measures and Implications for the Design of a Performance Measurement and Reporting System,   84      Selection of Specific Performance Measures,   98      Recommended Starter Set of Performance Measures,   103      Closing Comments,   109      References,   109 5   RESEARCH AGENDA   113      Development, Implementation, and Evaluation of New Measures,   114      Applied Research to Address Underlying Methodological Issues,   122      Design and Testing of Reporting Formats for Consumer Usability,   123      Evaluation of a System for Performance Measurement and Reporting,   124      Funding,   126      References,   126

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Performance Measurement: Accelerating Improvement     APPENDIXES     A   GLOSSARY AND ACRONYM LIST   129 B   NATIONAL ORGANIZATIONS INVOLVED IN PERFORMANCE MEASUREMENT   134 C   CASE STUDIES   144 D   TEN DESIGN PRINCIPLES   166 E   METHODOLOGY AND ANALYTIC FRAMEWORKS   170 F   Commissioned Paper: IMPROVING THE QUALITY OF QUALITY MEASUREMENT by John D. Birkmeyer, Eve A. Kerr, and Justin B. Dimick   177 G   STARTER SET OF MEASURES   204 H   Commissioned Paper: EFFICIENCY/VALUE-BASED MEASURES FOR SERVICES, DEFINED POPULATIONS, ACUTE EPISODES, AND CHRONIC CONDITIONS by Kyle L. Grazier   222 I   Commissioned Paper: TRANSITIONAL CARE PERFORMANCE MEASUREMENT by Eric A. Coleman   250 J   Commissioned Paper: PALLIATIVE CARE/END-OF-LIFE MEASURES by Sydney Dy and Joanne Lynn   287 K   BIOGRAPHICAL SKETCHES   322

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Performance Measurement: Accelerating Improvement Tables, Figures, and Boxes TABLES ES-1   Mapping of IOM Reports of the Committee on Redesigning Health Insurance to Congressional Mandates,   4 ES-2   Recommended Starter Set of Performance Measures,   11 1-1   Mapping of IOM Reports of the Committee on Redesigning Health Insurance to Congressional Mandates,   18 2-1   Major Limitations of Efforts to Measure the Performance of the U.S. Health Care System and Corresponding Attributes of a National System for Performance Measurement and Reporting,   55 2-2   Design Principles for a National System for Performance Measurement and Reporting,   58 3-1   Comparison of Alternatives for Achieving a National System for Performance Measurement and Reporting,   67 3-2   Concerns Regarding the Proposed NQCB and Responses to Those Concerns,   78 4-1   Gaps in Current Performance Measure Sets,   85 4-2   Recommended Starter Set of Performance Measures,   101 5-1   Priority Areas for Measure Development,   115 5-2   Impact Assessment of the NQCB,   125

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Performance Measurement: Accelerating Improvement B-1   National Organizations Involved in Performance Measurement,   134 C-1   Key Themes for Implementing Performance Measurement,   146 C-2   Total Cost Estimate per Review for Plan Members of HealthPartners, Inc.,   153 C-3   Total Cost Estimate per Review for Commercial Plan Members,   153 C-4   Community Medicine Associates’ Illustrative Measures Improvement in Performance Measures for Patients with Heart Disease and Diabetes Mellitus,   162 E-1   Analytic Frameworks Used by the Committee,   171 F-1   Primary Strengths and Limitations of Structure, Process, and Outcome Measures,   179 F-2   Quality Indicators for Ambulatory Care from the 2005 Version of the Health Plan Employer Data and Information Set (HEDIS),   180 F-3   Performance Measures for Hospital-Based Care,   182 F-4   High Leverage Measures Ready or Near Ready for Implementation in Quality Improvement of Selective Referral Initiatives,   197 G-1   AQA Ambulatory Care Measures (26 measures),   204 G-2   HQA Acute Care Measures (20 measures),   206 G-3   HEDIS 2005 Measures,   208 G-4   MDS Publicly Reported Measures on CMS’ Nursing Home Compare (15 measures),   220 G-5   OASIS Publicly Reported Measures on CMS’ Home Health Compare (11 measures),   220 G-6   NHQR’s ESRD Measures (5 measures),   221 H-1   “Value-Based” and Efficiency Metrics,   242 I-1   Patients’ Evaluation of Performance in California Survey (PEP-C-II) (CHCF),   272 I-2   Care Transitions Measure (CTM),   272 I-3   CAHPS® (AHRQ),   273 I-4   The Assessing Care of Vulnerable Elders Measure (ACOVE),   274 I-5   Potential Measures of Care Transitions,   280

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Performance Measurement: Accelerating Improvement J-1   Selected Potential Performance Measures for Palliative/End-of-Life Care,   290 FIGURES 2-1   A national system for performance measurement and reporting,   56 E-1   Donabedian’s model,   171 F-1   Relative usefulness of historical (1994–1997) measures of hospital volume and operative mortality in predicting subsequent (1998–1999) mortality,   187 F-2   Mortality associated with coronary artery bypass surgery in New York State hospitals, based on data from the state’s clinical outcomes registry,   193 F-3   30-day mortality rates for acute myocardial infarction at six hospitals in a large metropolitan region, relative to national average (1984–1994),   200 BOXES 4-1   Illustration of How Approaches to Address Gaps in Performance Measures Might Be Implemented,   86 4-2   Example of the Implementation of Composite Measures,   93 4-3   Criteria for Measure Selection Considered by the Committee and Other Selected Groups,   99 4-4   Core Domains of Ambulatory Care Surveys,   106 4-5   Hospital CAHPS Domains,   107 C-1   Barriers to Performance Measurement in Small Practices,   150 C-2   Key Lessons Learned from HealthPartners, Inc.,   154 C-3   Key Lessons Learned from an Internal Medicine Solo Practice,   156 C-4   Key Lessons Learned from Prime Care Family Practice,   157 C-5   Key Lessons Learned from Rochester Individual Practice Association,   159 C-6   Key Lessons Learned from GreenField Health,   161 C-7   Key Lessons Learned from Community Medicine Associates,   163 C-8   Key Lessons Learned from North Texas Medical Group,   164 I-1   Key Measurement Considerations,   258 I-2   Hospital Discharge Planning and Continuity of Care Practices,   268

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