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Suggested Citation:"Index." Institute of Medicine. 2006. Performance Measurement: Accelerating Improvement. Washington, DC: The National Academies Press. doi: 10.17226/11517.
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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

Suggested Citation:"Index." Institute of Medicine. 2006. Performance Measurement: Accelerating Improvement. Washington, DC: The National Academies Press. doi: 10.17226/11517.
×

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

Suggested Citation:"Index." Institute of Medicine. 2006. Performance Measurement: Accelerating Improvement. Washington, DC: The National Academies Press. doi: 10.17226/11517.
×

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

Suggested Citation:"Index." Institute of Medicine. 2006. Performance Measurement: Accelerating Improvement. Washington, DC: The National Academies Press. doi: 10.17226/11517.
×

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

Suggested Citation:"Index." Institute of Medicine. 2006. Performance Measurement: Accelerating Improvement. Washington, DC: The National Academies Press. doi: 10.17226/11517.
×

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

Suggested Citation:"Index." Institute of Medicine. 2006. Performance Measurement: Accelerating Improvement. Washington, DC: The National Academies Press. doi: 10.17226/11517.
×

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

Suggested Citation:"Index." Institute of Medicine. 2006. Performance Measurement: Accelerating Improvement. Washington, DC: The National Academies Press. doi: 10.17226/11517.
×

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

Suggested Citation:"Index." Institute of Medicine. 2006. Performance Measurement: Accelerating Improvement. Washington, DC: The National Academies Press. doi: 10.17226/11517.
×

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

Suggested Citation:"Index." Institute of Medicine. 2006. Performance Measurement: Accelerating Improvement. Washington, DC: The National Academies Press. doi: 10.17226/11517.
×

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

Suggested Citation:"Index." Institute of Medicine. 2006. Performance Measurement: Accelerating Improvement. Washington, DC: The National Academies Press. doi: 10.17226/11517.
×

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

Suggested Citation:"Index." Institute of Medicine. 2006. Performance Measurement: Accelerating Improvement. Washington, DC: The National Academies Press. doi: 10.17226/11517.
×

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

Suggested Citation:"Index." Institute of Medicine. 2006. Performance Measurement: Accelerating Improvement. Washington, DC: The National Academies Press. doi: 10.17226/11517.
×

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

Suggested Citation:"Index." Institute of Medicine. 2006. Performance Measurement: Accelerating Improvement. Washington, DC: The National Academies Press. doi: 10.17226/11517.
×

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

Suggested Citation:"Index." Institute of Medicine. 2006. Performance Measurement: Accelerating Improvement. Washington, DC: The National Academies Press. doi: 10.17226/11517.
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Performance Measurement: Accelerating Improvement Get This Book
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Performance Measurement is the first in a new series of an ongoing effort by the Institute of Medicine (IOM) to improve health care quality. Performance Measurement offers a comprehensive review of available measures and introduces a new framework to examine these measures against the six aims of the health care system: health care should be safe, effective, patient-centered, timely, efficient, and equitable. This new book also addresses the gaps in performance measurement and introduces the need for measures that are longitudinal, comprehensive, population-based, and patient-centered. This book 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.

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