Index

A

Acceleration Translation of Research into Practice, 155

Access to care

accountability for, 29

current measurement of, 3, 117

insurance coverage and, 23, 117

NQCB rationale, 67

in rural areas, 24

starter set of performance measures, 211–212

Accountability

for access to care, 29

goal of NQCB, 7

goals for performance measurement system, 2, 13, 55–56, 98, 167

of NQCB, 8, 9–10, 72–73

quality oversight, 25

shared accountability, 84, 88, 97–98, 122, 123, 168–169

in transitional care, 269

Accreditation

current performance measurement for, 44, 45–46

quality improvement efforts, 25, 41

for transitional care, 263, 267

Accreditation Council for Graduate Medical Education, 25

Acute care performance measures, 11, 106–107, 206–207

Acute myocardial infarction

mortality measurement, 120

starter set performance measures, 109, 116

Administrative data

case studies of data collection, 152, 156, 158

components of performance measurement system, 42–43

current set, 31–32

limitations, 27, 191–192, 227–228, 234

opportunities for improvement, 198–199, 232–233

structural measures of quality, 186

Adverse selection, 77, 124, 126

Advisory Council for Health Care Quality, 47

After-Death Bereaved Family Interview, 302, 310–311, 311

Agency for Healthcare Research and Quality, 43–44

capacity for management of national system, 65–66

clinical priority areas for quality improvement, 174

in community-level performance measurement, 97

NQCB and, 8–9, 71–72



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Performance Measurement: Accelerating Improvement Index A Acceleration Translation of Research into Practice, 155 Access to care accountability for, 29 current measurement of, 3, 117 insurance coverage and, 23, 117 NQCB rationale, 67 in rural areas, 24 starter set of performance measures, 211–212 Accountability for access to care, 29 goal of NQCB, 7 goals for performance measurement system, 2, 13, 55–56, 98, 167 of NQCB, 8, 9–10, 72–73 quality oversight, 25 shared accountability, 84, 88, 97–98, 122, 123, 168–169 in transitional care, 269 Accreditation current performance measurement for, 44, 45–46 quality improvement efforts, 25, 41 for transitional care, 263, 267 Accreditation Council for Graduate Medical Education, 25 Acute care performance measures, 11, 106–107, 206–207 Acute myocardial infarction mortality measurement, 120 starter set performance measures, 109, 116 Administrative data case studies of data collection, 152, 156, 158 components of performance measurement system, 42–43 current set, 31–32 limitations, 27, 191–192, 227–228, 234 opportunities for improvement, 198–199, 232–233 structural measures of quality, 186 Adverse selection, 77, 124, 126 Advisory Council for Health Care Quality, 47 After-Death Bereaved Family Interview, 302, 310–311, 311 Agency for Healthcare Research and Quality, 43–44 capacity for management of national system, 65–66 clinical priority areas for quality improvement, 174 in community-level performance measurement, 97 NQCB and, 8–9, 71–72

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Performance Measurement: Accelerating Improvement performance measurement program, 24–25, 45, 134–135, 155, 185, 230, 262 Preventive Quality Indicators, 94 recommendations for research, 14–15, 114, 126 Aging, population care assessment (ACOVE), 119, 262, 274, 302–303, 313 cost of care and, 20 Alzheimer’s disease, 89 Ambulatory care current performance measurement programs, 50, 178–179 information technology implementation, 26 patient perspective, 105–106 starter set of performance measures, 11, 103–106, 204–206 Ambulatory care Quality Alliance, 50, 102, 103, 136–137 American Academy of Pediatrics, 267 American Board of Internal Medicine, 51 American Board of Medical Specialties, 25 American College of Cardiology, 190 American Diabetes Association, 51 American Heart Association/American Stroke Association, 51 American Medical Association, 49, 50, 179 Anderson/Helms Referral Data Inventory, 262 Antibiotic therapy, 105 Assessing Care of Vulnerable Elders, 119, 262, 274, 302–303, 313 Asthma, 50, 104, 205 Audits of performance measurement system, 3, 77 data verification, 43 Australia, 52–53 B Bridges to Excellence, 25, 51, 230, 232, 265 Brown Atlas of Dying, 289–302 Brown University, 304 C California Healthcare Foundation, 119, 262, 265 Canada, 22 Cancer treatment, 21, 103–104, 116–117, 303–304, 305–306 Cardiovascular disease, 154, 155, 162 Care Management Workgroup, 266–267 Care Transitions. See Transitions, care in Care Transitions Measure, 257, 272–273 Case management, 26 Case-mix adjustment in performance measurement, 99–100, 121, 192, 258, 261, 269 Centers for Disease Control and Prevention, 74, 97 Centers for Medicare and Medicaid Services capacity to manage national performance measurement system, 65–66 clinical priority areas for quality improvement, 174 composite measures, 93 current performance measurement programs, 40, 46, 50, 51, 64, 138–139, 262 NQCB and, 8–9, 71–72 performance incentive program, 29 performance measurement program, 41, 43–44, 185 public reporting system, 27, 28 transitional care assessment, 252, 263–264 Chart review abstraction, 50, 107, 152–153, 269 limitations, 191 opportunities for improvement, 198–199, 232–233 Chronic illness clinical priority areas for quality improvement, 173–174, 175 complication rates, 13 coordination of care, 29 definition, 129 performance measurement, 103, 104 process measures, 186–188 quality of care assessment framework, 173 shortcomings of current performance measures, 89 shortcomings of health plan designs, 28, 29 trends, 104 See also Long-term care; specific disease Chronic obstructive pulmonary disease, 89

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Performance Measurement: Accelerating Improvement Clinicians and providers assistance for performance measurement implementation, 12, 102 case studies of performance measurement implementation, 150–164 current performance recognition programs, 51 data collection challenges, 49, 120 data collection requirements of NQCB, 79–80 definition, 129, 130 financial incentives for performance measurement, 148 individual-level performance measurement, 195–196 insurance program disincentives to quality care, 28–30 measures of efficiency, 226–227 performance data for consumers, 27–28 performance measurement methodology, 122–123 physician support for performance measurement, 145–148 possible negative effects of NQCB implementation, 77, 126 quality oversight, 25 reduced regulatory burden for high performance, 31 strategies for implementing performance measurement, 144–149 sustaining quality improvement, 148–149 in underserved areas, 81 See also Payment incentives Cognitive functioning assessment, 294–295 Colorado Foundation for Medical Care, 266 Colorectal cancer, 116–117 Community-level performance measurement, 97 Community Medicine Associates, 150, 151, 161–163 Competition, 27 Composite measures case study, 152 definition, 91–92 implementation, 93 obstacles to development of, 92–93 purpose, 13, 88 rationale, 92 scoring methodology, 93–94, 123 Comprehensive measurement components, 115–116 efficiency measurement, 116–117 equity measurement, 117–118 goals for performance measurement system, 84, 89, 95 patient-centered measures in, 118–119 purpose, 87, 89 research, 115–119 Confidentiality, 22, 77, 80–81, 100–102 Constipation assessment, 294–295 Consumer advocacy to improve quality of care, 27 Consumer Assessment of Health Plans Survey (CAHPS), 45 Consumer Assessment of Healthcare Providers and Systems (CAHPS), 45, 105–106, 107, 118–119 Consumer choice accountability and, 7, 167 current reporting system and, 27–28, 46 decision quality, 119 goals of performance measurement system, 2, 31, 43, 167 public reporting formats to enhance, 123–124 See also Access to care Consumer perspective ambulatory care performance measurement, 105–106 current efforts to measure, 41, 45, 118 data collection needs, 42 longitudinal experiences of care, 119 medical decision-making, 119 palliative care assessment, 300–301 perceptions of current health system performance, 22, 24 in performance measurement, 90, 118, 168 performance report design, 123–124 quality measurement framework, 173 starter set of performance measures, 213–214 transitional care experiences, 262–263 See also Patient-centered care Consumer-Purchaser Disclosure Project, 25 Continuity of care measures of, 90 palliative care assessment, 300–301 See also Transitions, care in Contract authority of NQCB, 8, 71, 114 Cooperative Cardiovascular Project, 195

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Performance Measurement: Accelerating Improvement Coordination of care, 28, 29, 75, 92, 108–109, 119, 251. See also Transitions, care in Coronary artery disease, 50 care delivery, 104 mortality measurement, 120 performance measurement case studies, 154, 155, 162 starter set of performance measures, 204–205 See also Acute myocardial infarction Cost of care birth defects, 105 in performance measurement, 91 public perception, 24 sources of increases in, 20 transitional care, 252 uninsurance rates and, 23 See also Efficiency of care Costs of performance data collection, 150, 199 Crossing the Quality Chasm: A New Health System for the 21st Century, 1, 3, 17, 53, 84, 172, 173–174 D Dartmouth Atlas, 232, 289 Data collection auditing of performance measurement system, 3, 10, 43, 77 challenges for small firms, 149–150 components of performance measurement, 42–43, 198–199 consumer surveys, 45 cost of, 150, 199 on efficiency of care, 227, 232–235 to improve performance measurement, 198–199 national vs. local, 100–102 NQCB requirements, 74, 76, 79–80 obstacles to starter set implementation, 100–102 patient record review costs, 152–154 on physician practices, challenges in, 49, 120 possible negative effects of NQCB implementation, 77, 125–126 privacy and confidentiality, 80–81 recommendations for NQCB, 7, 10–12, 68, 69, 76, 77, 102 sample size, 122–123, 188–189, 191 scope of, in health care system, 27 See also Electronic health records; Information technology; Performance measures; Chart review abstraction Dementia, 89 Department of Defense, 9, 72 Department of Health and Human Services, 8, 45, 71 Department of Veterans Affairs, 179, 190 Depression, 50 service delivery, 104 starter set of performance measures, 206 Diabetes, 149–150 performance measurement case studies, 154, 155, 156, 157, 160, 162 performance measures, 49, 50 service delivery, 31, 104 starter set of performance measures, 205 Diabetes Physician Recognition Program, 51 Dialysis centers, 28 Disease registries, 26, 31 Disease-specific mortality measures, 120, 121 Donabedian model for quality of care assessment, 170–172 Dyspnea assessment, 294–295 E Effectiveness of care current health care system, 21–22 definition, 130 goals, 1, 31, 172 starter set of performance measures, 208–211 Efficiency of care case study of physician performance profiling system, 158–159 cost calculations in measuring, 228–229 current measurement efforts, 41, 229–230 data sources, 227, 232–235 data standardization, 231 definition, 130, 222–224 episodic, 117 goals, 1, 31, 172, 224–225, 237–238 longitudinal, 116–117 measurement by medical specialty, 235 over time, 13

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Performance Measurement: Accelerating Improvement performance measurement, 103, 105, 225–230 productive efficiency, 223 quality dimensions of measurement, 231–232 research needs, 116–117, 230–238 resource allocation model, 223 resource attribution in measurement of, 235–236 risk adjustment and, 227–228, 237 starter set of performance measures, 11, 108–109 technical efficiency, 223 Elderly, 104 Electronic health records barriers to implementation, 149 current use patterns, 25–26 definition, 129 implementation case studies, 155, 156–157, 163–164 NQCB implementation, 10–12, 79–80 role in performance measurement, 167–168 Electronic prescribing, 25, 106–107 Emotional functioning assessment, 294–295 End-of-life/palliative care, 173 bereavement assessment, 312 care planning assessment, 296–299, 307–309 caregiver concerns, 311 challenges in performance measurement, 287, 313–317 current performance measurement, 173, 287, 288–304 definition, 288, 315–316 domains of measurement, 288 performance measurement rationale, 287–288 quality improvement projects, 304–307 quality of care, 22 recommendations for measurement, 307–313 research needs, 312–313, 317 site-of-death issues, 313–315, 316 survival time measurement, 317 End-stage renal disease mortality measurement, 120 NHQR performance measures, 221 starter set of performance measures, 11, 108, 221 Epidemiological research, 74 Episodic efficiency, 117 Equitable care current measurement efforts, 3, 41 data collection needs to assess, 13 definition, 131 goals, 1, 31, 172 NQCB rationale, 67 performance measurement goals, 96 regional variation, 24 research needs, 117–118 role of NQCB, 7–8 shortcomings of current health care system, 2, 23 Evidence-based practice NQCB design principles, 166–167 organizational characteristics and, 26 recommendations for NQCB, 73–74 F Family care-giving, 253–254 Federal Employees Health Benefits Program, 9, 72 Fee for service definition, 129 longitudinal measurement and, 89 Food and Drug Administration, 174 Forum for Health Care Quality Measurement and Reporting, 47 Foundation for Accountability, 84, 93, 173, 174 Funding assistance to providers for starter set implementation, 12, 102 to develop national performance measurement system, 6, 53–54 financial incentives for performance measurement, 148 National Quality Forum, 49 NQCB, 9, 14, 72–73, 79, 126 G Goals for health system efficiency measurement and, 237–238 local priorities, 10, 76 performance measure selection and, 192–195 performance measurement linkage, 3, 6 progress to date, 1–2

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Performance Measurement: Accelerating Improvement recommendations for, 10 role of NQCB, 7, 68, 89 selective referral, 177, 194–195 Government Accountability Office, 10 Grantmakers in Health, 14, 126 GreenField Health (Oregon), 149, 150, 159–160 H Health Insurance Portability and Accountability Act, 80 Health maintenance organizations, 44 Health Plan Employer Data and Information Set, 100 ambulatory care measures, 178–179 features, 44, 196–197 limitations, 27–28 record review costs, 152 starter set of performance measures, 107, 208–219 Health plans consumer decision-making, 27–28 current performance measurement, 27–28, 196–197 obstacles to high-quality care in design of, 28–30 provider performance incentives, 28–29, 41 stability assessment, 214–215 starter set performance measures, 11, 107–108, 214–215, 218–219 See also Insurance Health Resources and Services Administration, 8, 71–72 HealthPartners, Inc., 93, 152–154 Healthy People 2010, 94 Heart failure, 50, 104, 106 starter set of performance measures, 205 Heart/Stroke Physician Recognition Program, 51 Hip fracture treatment, 116–117 HIV screening, 105 Home health care current performance assessment programs, 46 public reporting system, 28, 220 starter set of performance measures, 107–108, 220 Home Health Compare, 46 Hospital CAHPS, 119, 262, 273 Hospital Quality Alliance, 138–139 Hospital Standardized Mortality Rate model, 121–122 Hospitals access, 117 acute care performance measurement, 106–107 care in transitions, 90, 119 current performance measurement programs, 40, 45–46, 185, 196–197 direct outcome measurement, 190–192 efficiency measurement, 229–230 health care spending in, 106 mortality measurement, 121–122 performance incentives, 29 public reporting system, 28 structural measures of quality of care, 185–186 Hypertension, 50 I Indian Health Service, 9, 72 Infant mortality, 22, 24, 104–105 Information technology barriers to adoption, 26 insurance payment disincentives to investment in, 29 recent initiatives to improve quality of care, 24 service delivery monitoring, 31 shortcomings of current practice, 25–26 for transitional care, 256–257, 269–270, 275 treatment reminders, 20, 25 See also Data collection Initiative for Pediatric Palliative Care, 305 Innovation NQCB and, 10, 76, 77, 81, 89, 145 system-level measurement and, 97 Institute for Clinical Systems Improvement, 152 Institute for Healthcare Improvement, 25, 229, 304 Institute of Medicine, 1, 10, 172, 173, 174 Insurance access to care and, 23 chronic care benefits, 28 cost of care and, 20 current population coverage, 23

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Performance Measurement: Accelerating Improvement need for performance measurement for system improvement, 32 provider payment systems, 29–30 in rural areas, 24 shortcomings of current system, 2 See also Health plans; Medicare; Uninsured population Integrated Healthcare Association, 51 Intensive care, 305 International comparisons health care spending, 1, 22 infant mortality, 104–105 information technology implementation, 26 palliative care, 306–307 performance measurement efforts, 52–53 quality of care, 1 J Japan, 22 Joint Commission on Accreditation of Healthcare Organizations budget, 73 capacity to manage national performance measurement system, 66 NQCB and, 64 performance measurement program, 43–44, 45–46, 49, 50, 140–141, 185, 230, 256 transitional care assessment, 252, 267–268 Joint replacement, 21 L Leadership and authority to develop and implement national performance measurement system, 6, 15, 30, 42, 53, 66, 67, 70, 89 recommendations for NQCB, 6–7, 8–9, 69, 71–72, 89 for research agenda, 114 shortcomings of current performance measurement initiatives, 3, 6 Leapfrog Group, 25, 107, 140–141, 185, 230, 232, 265 Life expectancy, 22 Local circumstances, NQCB sensitivity to, 10, 74, 75–76, 81 Long-term care starter set of performance measures, 11, 107–108, 220 See also Chronic illness; Time frame of measures Longitudinal measurement, 167 of continuity and transitions, 90, 119–120 of cost of care, 91 of disease-specific mortality, 120 efficiency evaluation, 116–117 goals of national performance measurement system, 84, 167 of outcomes, 90–91, 108–109, 120 of pain control, 120 rationale, 89–90, 119 shortcomings of current system, 87–88 starter set, 108–109 M Mammography, 151, 157 Medicaid consumer decision-making, 28 current performance measurement in, 44 See also Centers for Medicare and Medicaid Services Medicare charge of Redesigning Health Insurance Performance Measures, Payment, and Performance Improvement Project, 17–20 Conditions of Participation, 252, 269 consumer choices, 27 Medicare Advantage Plans, 27, 107 Medicare Payment Advisory Commission, 10, 73 Medicare Trust Fund, 9, 72 NQCB and, 9, 72 payment incentives and, 20 Quality Improvement Organization Program, 17–20, 25, 41, 266, 275 recommendations for public reporting, 9, 72 resource consumption patterns, 253 See also Centers for Medicare and Medicaid Services Medicare Prescription Drug, Improvement, and Modernization Act (2003), 2, 106, 174 Minimum Data Set, 46, 107–108

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Performance Measurement: Accelerating Improvement Mortality data collection needs, 13 disease-specific measures, 120, 121 patterns and trends, 21 performance measurement challenges, 120, 121–122 starter set performance measures, 109, 116 See also Hospital Standardized Mortality Rate Multidisciplinary team-based care, 29 N National Committee for Quality Assurance (NCQA) capacity to manage national performance measurement system, 66 collaborations in performance measurement, 49, 50 functions, 73 performance measurement activities, 27–28, 40, 43–44, 51, 64, 140–141, 178, 229–230, 231, 232 transitional care assessment, 265 National Health Information Network, 24 National Healthcare Disparities Report, 118 National Healthcare Quality Report, 97 National Hospice Data Set, 302 National Institutes of Health, 21 National Medicaring Quality Improvement Collaborative, 304 National Quality Coordination Board (NQCB) accountability, 8, 9–10, 72–73 alternatives, 65–66, 67–68 authorities, 6–7, 8–9, 69, 70, 71–72 contract authority, 8, 71 data collection requirements, 79–80 evidence-based decision-making in, 73–74 expertise, 8, 68–69, 71 functions, 7–8, 68, 83 funding, 9, 14, 72, 79, 126 impact assessment, 124–126 implementation monitoring, 76, 77 independence, 8, 70–71 membership, 8, 68, 71 obstacles to implementation, 69–70, 149–150 physician support for, 145–148 possible adverse consequences of implementation, 77–81, 125–126 privacy concerns, 80–81 rationale, 66–68, 78–81 recommendations for, 6–15, 68–69, 70–73, 76, 102, 114, 126 relationships with stakeholders and organizations, 8–9, 69, 70, 71–72, 76–77, 126 research functions. See Research agenda for NQCB resources for implementation, 148 role in setting health system goals, 7, 10, 68, 89, 166–167 sensitivity to local conditions, 10, 74, 75–76, 81 See also Performance measurement, national system of National Quality Forum (NQF), 142–143 accomplishments, 48, 143 acute care performance measurement, 106 ambulatory care performance measurement, 50, 178–179 capacity to manage national performance measurement system, 64, 66 end-of-life care assessment, 306, 317 funding, 73, 143 governance, 48, 142 hospital-based care assessment, 185, 229 origins and development, 47–48 purpose, 48, 73, 142 quality-of-care assessment, 232, 306 shortcomings, 48–49 starter set measures, 106 Strategic Framework Board, 48 transitional care assessment, 263–264 National Surgical Quality Improvement Program, 190, 191, 197 National Technology Transfer and Advancement Act, 48 NCQA. See National Committee for Quality Assurance North Texas Medical Group, 151, 163–164 NQCB. See National Quality Coordination Board Nursing Home Compare, 46, 220, 307 Nursing homes early performance assessment programs, 46

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Performance Measurement: Accelerating Improvement public reporting system, 28, 220 starter set of performance measures, 107–108 O Organizational characteristics data collection needs, 42 Donabedian model for quality of care assessment, 170–172 health care system, 27 information technology implementation, 26 NQCB, 78–79 structural measures of care, 185–186 Osteoarthritis, 50 Outcome and Assessment Information Set, 46, 107–108 Outcomes measurement challenges in provider evaluation, 49, 120 current quality of care assessment programs, 190–192 disease-specific mortality, 120, 121 in efficiency of care measurement, 116 in end-of-life/palliative care, 313–315 hospital-specific mortality, 121–122 longitudinal measures, 89–91 pain control, 120 process measures and, 186–188, 189 standardization, 42 starter set of performance measures, 11, 108–109 structural measures, 185–186 in transitional care, 90, 119, 263 P Pain management assessment, 49, 120, 290–293, 304, 309–310 Palliative care. See End-of-life/palliative care Palliative Care Benchmarking, 303 Pathways to Quality Health Care reports, 2–3, 17–20 Patient-centered care current measurement efforts, 13, 41 definition, 118, 130 health care system goals, 1, 31, 172 patient-level measurement, 13, 42–43, 84, 88, 91–92, 95–96, 118–119, 201 Patient’s Bill of Rights, 48 Patients’ Evaluation of Performance in California, 262–263, 265, 271–272 Payment incentives case study, 159 current health plan shortcomings, 28–29 current quality improvement efforts, 29, 41 goals of Redesigning Health Insurance Performance Measures, Payment, and Performance Improvement Project, 20 impact of performance measurement, 7 need for performance measures to implement, 2, 30–31 rationale, 31 strategies for health system improvement, 1, 2–3 in transitional care, 269 Pediatric palliative care, 305 Performance measurement, national system of accountability in, 13, 55–56 alternatives to, 65–68 challenges to development and implementation, 42, 53–54 data collection and analysis capabilities for, 42–43 design principles, 57, 84, 166–169 desirable attributes, 3, 54–57 as disincentive to innovation, 77 evaluation of, 14, 114, 124–126, 169 implementation, 30, 54, 57 international comparison, 52–53 leadership needs, 6, 15, 66 lessons from NQF, 49 local considerations, 10 pioneering programs, 43–46 prospects for health system without, 15, 64–65, 79 public health role, 57 quality improvement role, 56–57 rationale, 2, 3, 15, 30–32, 46–47, 63 recent collaborative efforts, 46–51 resistance to, 69–70, 149 shortcomings of current initiatives to develop, 3–6, 49, 51, 53–54, 64, 68 strategies for implementing, in health care organizations, 144–149 See also National Quality Coordination Board (NQCB); Performance measures

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Performance Measurement: Accelerating Improvement Performance Measurement Coordinating Council, 49 Performance measures access to patient-level data, 42–43 approaches to improve health care, 84–86, 87–88 care across settings, 89–90, 95 care across time, 13, 89, 90 case studies of implementation, 150–164 chronic care, 104 community-level, 97 composite measures, 13, 88, 91–94 comprehensive measurement, 84, 87, 88, 89, 95, 115–119, 166 condition-specific, 196 consistency in application, 3 criteria for selection, 98, 192–196 current leading sets, 84, 170, 178–179, 185, 196–197 definition, 130 development methodology, 122–123 efficiency of care, 103, 105, 116–117, 229–230 end-of-life/palliative care, 288–304, 307–313 equity of care, 117–118 evaluation of, 177–178 longitudinal, 84, 87–88, 89–91, 116–117, 119–120, 167 outcome measures, 190–192 pain control, 120 patient-centered, 13, 84, 88, 91–94, 95–96, 118–119 population-based, 13, 84, 88, 91, 94–96, 167 prenatal care, 104–105 preventive care, 103–104 procedure-specific, 196 process measures, 186–190 rationale, 79, 177, 255–256 reliability, 19–201 research agenda, 114–122, 198–201 role of NQCB in developing, 7, 68 scope, 12, 89 shared accountability, 84, 88, 97–98, 122, 168–169 shortcomings of current set, 12–13, 31–32, 41, 43, 83, 84, 86–98, 99–100, 175 standardization requirements, 42, 43 structure measures, 185–186 systems-level, 13, 91, 96–97, 121 transitional care, 261–264, 270–274 See also Performance measurement, national system of; Starter set of performance measures Pharmacy services data management, 234–235 electronic prescribing, 25, 106–107 public perception of drug costs, 24 in transitional care, 234–235 Physician Consortium for Performance Improvement, 50, 142–143, 179 Physician Practice Connections, 51 Pneumonia, 106 Population-based measurement, 84, 88, 91, 94–96, 167 Population-based measures, 13 Preferred provider organizations, 107 Prenatal health performance measurement, 50, 103, 104–105 starter set of performance measures, 206 President’s Advisory Commission on Consumer Protection and Quality in the Health Care Industry, 47 Prevention performance measurement, 50, 103–104 population health improvement, 94 in prenatal care, 105 process measures of, 186–188 role of national performance measurement system, 57 starter set of performance measures, 204 Prime Care Family Practice, 151, 155–157 Privacy, 27, 80–81 Private sector research, 21 Process of care measurement, 186–190 in transitions, 260, 261, 262 Providers. See Clinicians and providers Public good, 6 Public reporting on performance case studies, 154 current programs, 6, 27–28, 40–41 evidence of quality improvement from, 63–64 format design and testing, 14, 15, 114, 123–124 impact of performance measurement, 7 implementation of national system, 57 local considerations, 10 national performance measurement system and, 2, 3, 15, 30–31, 57 rationale, 31

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Performance Measurement: Accelerating Improvement recommendations for Medicare, 9, 72 role of NQCB, 7, 67, 68 strategies for health system improvement, 1 Purchasing practices contract authority of NQCB, 8, 71, 114 recent initiatives to improve quality of care, 25 Q Quality improvement, 2 clinical priority areas for, 173–174 collaboratives, 1 consumer advocacy for, 27 current efforts, 1–2, 24–25, 41 definition, 131 end-of-life/palliative care, 304–305 environmental barriers to, 26 government regulation for, 30 market incentives for, 27, 30 need for performance measures for, 2, 3, 15, 30–32, 56–57 obstacles to, 2 organizations, 17–20 professional education and monitoring for, 30 sustaining, after performance measurement implementation, 148–149 in transitional care, 255–261, 264–270 See also Quality of care Quality Improvement Organizations. See Medicare, Quality Improvement Organization Program Quality of care analytic frameworks for assessing, 84, 170, 201 case studies of performance measurement implementation, 150–164 changes needed to improve, 17 cost of care and, 20 current physician recognition programs, 51 current system, 21–22, 25–26 demographic inequities, 23 direct outcome measures, 190–192 efficiency of care measurement, 116, 231–232 goals, 1, 31, 130–131, 172 health care spending and, 1–2, 22 health plan design as obstacle to, 28–30 impact of performance measurement, 7, 63 NQCB impact assessment, 124–126 over time, 13, 89, 90 oversight, 25 patient perceptions of, 22, 24 population health, 94 practice characteristics and, 26 process measures, 186–190, 260, 261, 262 public reporting effects on, 63–64 role of NQCB, 7, 74–75, 80 scope of measurement, 12 structural measures, 185–186, 260–261 in transitions, 250, 254–255 See also Quality improvement Quality of Care for Oncologic Conditions and HIV, 303–304 R Race/ethnicity current inequities in health system, 2, 23 data collection needs, 13, 118 treatment outcome disparities, 103–104, 118 treatment outcome measurement, 120 RAND Corporation, 93, 197, 262, 303–304 Redesigning Health Insurance Performance Measures, Payment, and Performance Improvement Project, 2–3, 17, 24 Regional variation disparities in care, 118 health care spending, 2, 22 quality of care, 2, 22 Regulation to improve quality of care, 30 reduced regulatory burden for high-performance providers, 31 Research current system, 21, 114 efficiency of care measurement, 230–238 to improve performance measurement, 198–201 NQCB agenda. See Research agenda for NQCB palliative care, 312–313 performance report design, 123–124 recent initiatives to improve quality of care, 24–25

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Performance Measurement: Accelerating Improvement Research agenda for NQCB components, 14, 113–114 contracting and grantmaking authority, 114 efficiency of care, 116–117 funding, 14 goals, 7, 68, 74–75, 109, 113, 115 new measure development and implementation, 114–123 participants, 14–15, 126 performance measurement system evaluation, 124–126 recommendations, 14–15, 114, 126 Risk adjustment, 67, 77 definition, 131 direct outcome measurement and, 191–192 efficiency measurement and, 227–228, 237 limitations of current system, 6, 67, 77, 99–100 research recommendations, 14, 114, 122 Robert Wood Johnson Foundation, 305 Rochester Individual Practice Association, 158–159 Rural areas, 81 access to care in, 24, 117 NQCB implementation, 81, 84 S Safety of care current health care system, 21–22 definition, 130 goals, 1, 31, 172 recent initiatives to improve, 24–25 in transitions, 254–255 Scope of performance measurement, 12 Selective referral, 177, 194–195 Shared accountability, 84, 88, 97–98, 122, 123, 168–169 Small practice settings challenges to quality improvement in, 17 data collection for performance comparison, 28, 49 information technology implementation, 25 obstacles to performance measurement, 49, 149–150 sustaining quality improvement, 148–149 Society for Hospital Medicine, 266 Society for Thoracic Surgeons, 190 Socioeconomic status current inequities in health system, 2 data collection needs, 13, 118 Spending consumer health care, 22 current research system, 21 electronic health record implementation, 155, 156–157, 163–164 in hospitals, 106 patient record review costs, 152–154, 162 physician performance profiling system, 158 quality of care and, 1–2, 22 regional variation, 2, 22 in transitional care, 252–253 See also Cost of care Standardization of data characteristics, 42 current system, 43, 67 efficiency measures, 231 rationale, 42 resistance to national program for, 69–70 role of NQCB, 78–79, 83 Standards-setting authority of NQCB, 8–9, 71–72 local considerations, 10 Starter set of performance measures, 204–221 acute care, 11, 106–107, 206–207 ambulatory care, 11, 103–106, 204–206 development methodology, 84, 170, 174–175 efficiency of care, 11, 108–109 end-stage renal disease, 11, 108 health plans, 11, 107 long-term care, 11, 107–108 obstacles to implementation, 84, 100–102 recommendations, 10–12, 100, 102 Strategic Framework Board, 48 Stroke, 89 Structural measures of quality of care, 185–186, 260–261 Surgery complications, 106 direct outcome measurement, 190 Symptom Management/End-of-Life, 306 System-level measurement, 13, 84, 88, 91, 96–97, 121–122

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Performance Measurement: Accelerating Improvement T Technological advancement in medicine accomplishments, 21 cost of care and, 20 Time frame of measures, 89, 90 efficiency measurement, 116, 233–234 long-term care, 11, 90, 107–108, 220 shortcomings of current system, 13, 89 Timeliness of care definition, 130 goals, 1, 31, 172 To Err Is Human: Building a Safer Health System, 1 Tobacco cessation programs, 104, 106 Transitions, care in accountability in, 269 barriers to quality improvement, 268–270 barriers to quality in, 250, 251–252 case-mix adjustment in performance measurement, 269 current performance measures, 261–264, 280–286 current quality improvement efforts, 264–268 data sources, 259 definition, 90, 129, 250–251 elements of, 251 family care-giving in, 253–254 goals, 251 health care setting considerations, 259–260 information technology in, 269–270, 275 medical information transfer in, 235, 256–257 patterns and trends, 253 performance measurement, 90, 119, 255–261 process measures of quality of care, 260, 261, 262 quality problems in, 254–255 recommendations for performance measurement, 270–274 to self-care, 253 significance of, for quality improvement, 250 strategies for improving measurement, 274–275 structural measures of quality of care, 260–261 Transplantation, organ, 21 Treatment reminders, 20, 25, 26 TRICARE program, 9, 72 U Uninsured population access to care, 23 economic outcomes, 23 patterns and trends, 2, 23 United Hospital Fund, 304 United Kingdom, 22, 52, 306 University of Colorado Health Science Center, 119 U.S. Preventive Services Task Force, 161 Utilization end-of-life care, 314–315 starter set of performance measures, 215–218 V Value-based purchasing, 41 Veterans Health Administration, 9, 63, 72, 304 Vulnerable populations, 131

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Performance Measurement: Accelerating Improvement