Envisioning the National Health Care Quality Report (2001) / Chapter Skim
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Defining the Contents of the Data Set: The National Health Care Quality Framework
Defining the Contents of the Data Set: The National Health Care Quality Framework
Pages 40-75
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From page 40... ...
RECOMMENDATION RECOMMENDATION 1: The conceptual framework for the National Health Care Quality Report should address two dimensions: components of health care quality and consumer perspectives on health care needs. Components of health care quality the first dimension—include safety, effectiveness, patient centeredness, and timeliness.
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From page 41... ...
3. Patient centeredness refers to health care that establishes a partnership among practitioners, patients, and their families (when appropriate)
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From page 42... ...
Although it will provide continuity for the Quality Report and the measures, the framework should be considered dynamic. In the long term, it may have to be adjusted in response to changes in the conceptualization of quality and/or significant changes in the nature of the U.S.
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From page 43... ...
Components of Health Care Quality For each of the four components of quality—safety, effectiveness, patient centeredness, and timeliness—the committee defined a set of subcategories (Table 2.1) and specific examples of potential measures for the National Health Care Quality Report (Boxes 2.1 to 2.4~.' The components of quality can be thought of as subsets of quality of care, but they are not completely independent of each other.
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From page 44... ...
In operational terms, improving safety means designing and implementing health care processes to avoid, prevent, and ameliorate adverse outcomes or injuries that stem from the processes of health care itself (National Patient Safety Foundation, 2000~. Safety is best understood in terms of injuries that occur to patients and the errors or latent failures that lead to these injuries or harm Although both perspectives are essential in building a safer health care system, the overriding priority in the short term is the reduction of injuries or harm to patients.
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From page 45... ...
DEFINING THE CONTENTS 45 | ~ B0942~1 Ekam:plesof:pjte~asin~Which~ofSafety ~ ~ ~~:-~:.~ ~~ ::: ;~ ~~ ~-:~ ~~ ~~ ::: :: ::::'.,=~uipatent cardiac stress test (e.g., ~ ~ ~ ~ .
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From page 46... ...
has issued a report to the President defining needed actions to improve patient safety, which begins to address many of these issues (Quality Interagency Coordination Task Force, 2000~. The Quality Report should include measures to assess the effects of some of these actions as they are implemented.
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From page 47... ...
Preventive Services Task Force, 1996~. The effectiveness of preventive care can also be assessed selectively by examining screening and interventions for specific conditions or problems such as childhood immunizations (Centers for Disease Control and Prevention, 1999)
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From page 50... ...
Practice guidelines and well-tested quality measures are available for a variety of conditions including diabetes, acute myocardial infarction, heart failure, asthma, breast cancer, pneumonia, and spoke (Health Care Financing Adm~nis~ation, 2000; Jans et al., 2000; National Committee for Quality Assurance, 2000; Rolnick et al., 2000; Shiffman et al., 2000; Soumerai et al., 1998~. However, well-def~ned measure sets that include both process and outcome measures and cover the entire spectrum of care are available for only a few conditions such as diabetes (American Diabetes Association, 1998; Health Care Financing Administration, 2000; Loeb, 2000; Tuckson, 2000~.
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From page 51... ...
An effective partnership also involves the opportunity for patient selfmanagement or patient involvement in care for specific conditions (generally chronic problems) , including self-monitoring and shared goal setting, so that a true partnership between the clinician and the patient and his or her family can be established (Center for the Advancement of Health and Milbank Memorial Fund, 1999~.
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From page 52... ...
Finally, an effective partnership is facilitated by culturally competent health care. For example, patient centeredness can be furthered when patients receive information in their own language, when the clinicians have greater awareness of potential communication difficulties, and most importantly, when care is provided taking into account the context of the patient's cultural beliefs and practices (Chin, 2000; Langer, 1999; Rivadeneyra et al., 2000; Robins et al., 2001~.
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From page 53... ...
Delays in obtaining care can directly affect the effectiveness of care and health outcomes. In some cases, delays in care can endanger the life of the patient for example, delays in receiving antibiotics for pneumonia (Centers for Disease Control and Prevention, 1995; Health Care Financing Administration, 2000; Meehan et al., 1997)
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From page 54... ...
~~ ~ ~W in,: 4~41 Care Financing Administration, 2000; Marciniak et al., 1998; Ryan et al., 1999 be pleasured by the absence of adminisTimeliness in getting to cared can cific conditions (for example' time from d trative-based delays in care p agnosis to treatment for breast cancer)
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From page 55... ...
Together, these consumer perspectives on health care needs represent the most important reasons why people seek care. They also reflect Me life cycle of their involvement win the health care system.
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From page 56... ...
To avoid illness, the health care system should encourage the development of healthy behaviors, facilitate early detection of illness, and educate consumers about how they can reduce health risks. From the point of view of clinicians, this category includes measures of preventive care.
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From page 57... ...
Consumer Perspectives on Health Care Needs as Reflected in Care for Specific Health Conditions In addition to examining the quality of health care overall, presenting consumer perspectives on health care needs according to specific conditions will increase the usefulness of the National Health Care Quality Report and its policy relevance. In particular, it will increase understanding of the quality of care for
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From page 58... ...
58 ENVISIONING THE NA TIONAL HEALTH CARE QUALITYREPORT particular health problems on the part of consumers and policy makers. Box 2.5 presents an example of how measures regarding care for breast cancer could be classified using the categories of consumer perspectives on health care needs.
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From page 59... ...
However, when comparing quality of care for different conditions it will be important to take into account possible confounding of the results by differences in He specific quality indicators used for each condition rawer than Rue differences in the underlying quality of care. The specific conditions or clinical areas that are the focus of the Quality Report can change from year to year, but they should be limited in number.
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From page 60... ...
Using a Matrix to Portray the Framework The framework provides a way of classifying possible measures for the National Health Care Quality Report. Measures included in the report should reflect the components of health care quality for one or more consumer perspec
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From page 61... ...
The four consumer perspectives on health care needs staying healthy, getting better, living with illness or disability, and coping with the end of life are shown as rows, while the components of health care qualit~safe~, effectiveness, patient centeredness, and timeliness are shown as columns. Potential quality measures can be placed in one of the cells corresponding to the particular component of quality and the specific health care need it most reflects.
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From page 62... ...
Equity can also be assessed across consumer perspectives on health care needs and for specific conditions. Variations in the quality of care for any quality component may be analyzed by examining disparities among groups by race, ethnicity, gender, age, income, geographic location, or insurance status and other socioeconomic conditions.
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From page 63... ...
Variations in quality may also be clinically driven, as is the case for variations in the quality of care across different chronic conditions, determined largely by the state of the science. Clinically driven variations are not the focus of this discussion because they are not indicators of equity; rather they are indicators of technological advances and of the extent of the evidence base regarding care for specific conditions.
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From page 64... ...
, the importance of examining issues of equity in quality of care should not be underestimated. As mentioned in Chapter 1, the Quality Report, together with a planned report on disparities in heals care delivery mandated by the same legislation, should help to remedy this situation (Healthcare Research and Quality Act, l999:Sec.
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From page 65... ...
DEFINING THE CONTENTS 65 ~ ~ ~ 'at :~ -":~sm' 'ller~or law''- 'I ~-'-22 ' ~ '~:2~ -- it- ' :-'2-~ ~ ~~ ~ ~~ ~~U=U OODIl Its ;UVOI~C 11~1 "a ~ ~ ~;~ ~;~ ~ -ma ;.
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From page 66... ...
These questions refer to the components of health care quality and consumer perspectives on health care needs, including care for specific conditions. The measures included in the framework can be used to examine equity, or how certain groups of people fare compared to others, and to describe the evolution in He quality of care being delivered in He United States over time.
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From page 67... ...
org/uninsured/lack-contents.htm. American Diabetes Association.
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From page 68... ...
Commissioned paper for the Institute of Medicine Committee on the National Quality Report on Health Care Delivery. Bindman, Andrew B., Kevin Grumbach, Dennis Keane, Loren Rauch, and John Luce.
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From page 69... ...
Journal of the American Medical Association 267~16~:2221-2226. Expert Panel on Prenatal Care.
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From page 70... ...
1995. Variations in the utilization of coronary angiography for elderly patients with an acute myocardial infarction.
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From page 71... ...
2000b. Joint Commission and Health Care Financing Administration Core Measure Crosswalks for Acute Myocardial Infarction, Heart Failure and Community Acquired Pneumonia ton-line]
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From page 72... ...
Commissioned paper for the Institute of Medicine Committee on the National Quality Report on Health Care Delivery. McGlynn, Elizabeth A., and Robert H
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From page 73... ...
2000. Patient centeredness in medical encounters requiring an interpreter.
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From page 74... ...
1998. Effect of local medical opinion leaders on quality of care for acute myocardial infarction: a randomized controlled trial.
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From page 75... ...
Home Health Care Services Quarterly 17~2~: 1-20. Tuckson, Reed, 2000.
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