States and two in other countries that provide online comparative hospital performance information (Delmarva Foundation, 2005).

Widespread concerns about quality have stimulated quality improvement efforts at all levels of the health care system. Quality monitoring and improvement are critical responsibilities of all types of health care providers, and quality improvement is now regarded as a core competency that all types of health care professionals should possess. Major accreditation and certification bodies have increased requirements for monitoring and demonstrating improvements in quality and safety (ABIM, 2005; JCAHO, 2004; NCQA, 2000). And Medicare, through its Quality Improvement Organization Program, provides about $350 million per year for surveillance functions and technical assistance (U.S. DHHS, 2004a).

In an effort to reward providers for improvements in quality, many private purchasers and health plans have implemented pay-for-performance programs that characteristically link a modest amount of provider payments to performance across a number of measures (Dudley, 2005; Rosenthal and Booth, 2004; Rosenthal et al., 2005). In addition, the public sector has been active in conducting demonstration projects linking performance on a set of standardized measures to bonuses, calling for “value-based purchasing” (U.S. Congress, 2005a,b; U.S. DHHS, 2002, 2004b).

Reflecting the priority accorded to improving quality, many private organizations, such as health plans, hospitals, provider groups, and professional associations, have made considerable progress in developing measures that capture important areas of clinical care and organizational performance. Measures of patients’ perceptions or experiences of care have emerged through efforts of consumer advocates. CMS has also demonstrated leadership in encouraging the development of these measures through demonstration projects.

The development of multiple quality measures has been driven by stakeholders eager to see certain features of care recognized and rewarded as part of quality improvement initiatives. These efforts rely greatly upon consensual efforts and private support from key membership organizations. Yet while the private sector has made valuable contributions in moving the quality agenda forward through pioneering and innovative efforts, the emerging quality measures resulting from these efforts are unable to address all six aims for the health care system articulated in the Quality Chasm report (IOM, 2001): safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity. The current patchwork of existing measures fluctuates over time and includes many gaps when assessed against the six aims. Few or no measures exist in the areas of efficiency, equity, and patient-centeredness. In addition, the variety of measures that exist in certain areas creates competing demands for data that can be burdensome to providers.

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