Toward Quality Measures for Population Health and the Leading Health Indicators (2013) / Chapter Skim
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4 Using the Quality Measures
4 Using the Quality Measures
Pages 77-94
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From page 77... ...
The chapter's primary focus on health care and public health is not intended to suggest that there are no other stakeholders. It is a reflection of the most obvious locus for collaboration to improve the health of communities, and of common ground, such as the fact that many health departments provide clinical care services, and the fact that several provisions of the ACA offer further opportunities for health care delivery and public health practice to "meet in the middle" (see, for example, Stoto [2013]
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From page 78... ...
. Earlier IOM reports have explained how a multisectoral health system can improve population health and increase the value realized on the nation's investment (IOM, 2011a, 2012)
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From page 79... ...
There are a growing number of opportunities to use measures of quality. Healthy People 2020 is directed at the country's entire health enterprise -- not merely at governmental public health agencies, but also at health care delivery organizations at all levels, at community-based organizations involved in health improvement, at the business community, at government agencies working in areas relevant to health (e.g., transportation and education)
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From page 80... ...
The revised illustration, shown in Figure 4-1, places governmental public health infrastructure at the center of the process for
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From page 81... ...
requirements for tax-exempt hospitals to include conducting a community health needs assessment, the ACA's promotion of accountable care organizations as a governance tool for coordinated and high-quality care, the growing influence of the Three-Part Aim framework, and the creation of a national public health accreditation program that requires state and local public health agencies to conduct health needs assessments and develop improvement plans. The committee has identified some of the primary users and purposes for the quality measures.
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From page 82... ...
Community health improvement planning is a common activity of local and state health departments, and a quick search of the Web results in hundreds of examples of community health improvement plans developed by an array of jurisdictions and organizations. The National Association for County and City Health Officials (NACCHO)
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From page 83... ...
More recent efforts for planning and prioritization have been undertaken using America's Health Rankings for data at the state level and the County Health Rankings at the county level. The committee views the nine characteristics of quality in public health identified by the HHS Public Health Quality Forum as a guide for state and community health improvement plans and their implementation.
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From page 84... ...
One potential leverage point is the role of states in cases where the state health agency provides hospitals with certificates of need, in which case the state agency could require that the hospital collaborate with the local public health agency. Nevertheless, this IRS requirement has tremendous potential to facilitate collaboration in the multisectoral health system, and especially between public health and clinical care, to improve population health.
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From page 85... ...
, "a free Web-based platform designed to assist nonprofit organizations, state and local health departments, financial institutions, and other organizations seeking to better understand the needs and assets of their communities, and to collaborate to make measurable improvements in community health and well-being" (Community Commons, 2013)
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From page 86... ...
Some community health improvement efforts are driven by a partnership between health care, public health entities, and entities from other sectors, such as academic institutions. Examples can be found across
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From page 87... ...
This observation echoes some of the findings of the National Quality Forum (NQF) Population Health Endorsement Maintenance Steering Committee that attempted to identify and endorse population health measures as part of the larger NQF process and faced considerable limitations and challenges in its work (Jarris and Stange, 2012)
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From page 88... ...
The committee also finds that additional development is needed by users of the Three-Part Aim to incorporate evi dence-based measures representing social and environmen tal determinants of health, equity, and the concept of total population health. The potential of the Three-Part Aim as a transformative concept could be strengthened if government public health agencies are able to perform the role of conveners and facilitators of stakeholders and advisers in ensuring that community health (needs)
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From page 89... ...
programs such as Community Transformation Grants. KEY REQUIREMENTS FOR USING QUALITY MEASURES FOR IMPROVING POPULATION HEALTH The committee recognizes that in many ways the use of measures of quality in order to improve population health is still in its infancy.
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From page 90... ...
However, over time, improvement teams and coalitions could develop measures in areas where there are gaps, test and use such measures, and then submit successful measures to an independent body for consideration and endorsement for broad use, as suggested in Recommendation 2-3. Another important requirement for quality measures to improve population health is to measure equity by examining health disparities and changes in disparities.
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From page 91... ...
has expanded greatly in recent years. Examples from the public sector include the ACA-established National Prevention, Health Promotion, and Public Health Council, which brings together multiple cabinet secretaries and agency heads under the leadership of the Surgeon General, and "health-in-all-policies" efforts such as the joint Sustainable Communities Initiative of the Department Housing and Urban Development, the Department of Transportation, and the Environmental Protection Agency.
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From page 92... ...
The plan is tailored to the needs of the community using direct community input at the development stage, where health care and health concerns can be a major focus. The committee believes that financial institutions can use measures of quality to focus on improving total population health as one of their objectives in community development.
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From page 93... ...
. Substantial progress in improving population health is needed, and quality measures can help public health departments, health care organizations, communities, and many others to work collaboratively to maximize strengths and begin to alter the conditions for health.
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