ucts specific to ambulatory care: the CAHPS Health Plan Survey and the CAHPS Clinician and Group Survey (AHRQ, 2004). Core domains in each of these surveys are presented in Box 4-4.
Of the $1.5 trillion spent on health care in 2002, 33 percent is attributable to hospital care (American Hospital Association, 2004). Widespread performance measurement in hospitals has built upon past efforts involving collaboration among a multitude of stakeholders, as discussed in Chapter 2. These efforts have culminated in the measures chosen by the Hospital Quality Alliance (HQA), a partnership of 13 public and private sponsors (see Appendix G-2). Measures were selected on the basis of severity of clinical condition and ease of data submission for public reporting. The 20 measures endorsed by the National Quality Forum (NQF) originate from the voluntary starter set of 10 measures that, under the Medicare Prescription Drug, Improvement and Modernization Act of 2003, are linked to a 0.4 percent reduction in Medicare annual payment update if not reported. Currently, an estimated 4,200 hospitals are participating in this public reporting effort. As with the AQA measures, the committee proposes the reporting of these individual measures as patient-level composites for the following areas: acute coronary infarction, heart failure, pneumonia, smoking cessation, and surgical complications.
In an effort to address patient safety in the hospital setting, the committee proposes assessment of the following structural measures: (1) implementation of computerized provider order entry for prescriptions, (2) staff-