Recommendations for the National Healthcare Quality Report
(IOM, Envisioning the National Healthcare Quality Report, 2001)
- 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. Consumer perspectives on health care needs—the second dimension—reflect changing consumer needs for care over the life cycle associated with staying healthy, getting better, living with illness or disability, and coping with the end of life. Quality can be examined along both dimensions for health care in general or for specific conditions. The conceptual framework should also provide for the analysis of equity as an issue that cuts across both dimensions and is reflected in differences in the quality of care received by different groups of the population.
- The Agency for Healthcare Research and Quality should apply a uniform set of criteria describing desirable attributes to assess potential individual measures and measure sets for the content areas defined by the framework. For individual measures, the committee proposes 10 criteria grouped into the three following sets: (1) the overall importance of the aspects of quality being measured, (2) the scientific soundness of the measures, and (3) the feasibility of the measures. For the measure set as a whole, the committee proposes three additional criteria: balance, comprehensiveness, and robustness.
- The Agency for Healthcare Research and Quality should have an ongoing independent committee or advisory body to help assess and guide improvements over time in the National Health Care Quality Report.
- The Agency for Healthcare Research and Quality should set the long-term goal of using a comprehensive approach to the assessment and measurement of quality of care as a basis for the National Health Care Quality Data Set.
- When possible and appropriate, and to enhance robustness, facilitate detection of trends, and simplify presentation of the measures in the National Health Care Quality Report, the Agency for Healthcare Research and Quality (AHRQ) should consider combining related individual measures into summary measures of specific aspects of quality. AHRQ should also make available to the public information on the individual measures included in any summary measure, as well as the procedures used to construct them.
- The National Health Care Quality Data Set should reflect a balance of outcome-validated process measures and condition- or procedure-specific outcome measures. Given the weak links between most structures and outcomes of care and the interests of consumers and providers in processes or practice related aspects as well as outcome measures, structural measures should be avoided.
- Potential data sources for the National Health Care Quality Data Set should be assessed according to the following criteria: credibility and validity of the data, national scope and potential to provide state-level detail, availability and consistency of the data over time and across sources, timeliness of the data, ability to support population subgroup and condition-specific analyses, and public accessibility of the data. In addition, in order to support the framework, the ensemble of data sources defined for the National Health Care Quality Data Set should be comprehensive.
- The Agency for Healthcare Research and Quality will have to draw on a mosaic of public and private data sources for the National Health Care Quality Data Set. Existent data sources will have to be complemented by the development of new ones in order to address all of the aspects included in the proposed framework and resulting measure set. Over the coming decade, the evolution of a comprehensive health information infrastructure, including standardized, electronic clinical data systems, will greatly facilitate the definition of an integrated and comprehensive dataset for the Quality Report.
- The data for the National Health Care Quality Report should be nationally representative and, in the long term, reportable at the state level.
- The National Health Care Quality Report should be produced in several versions tailored to key audiences—policy makers, consumers, purchasers, providers, and researchers. It should feature a limited number of key findings and the minimum number of measures needed to support these findings.
Source: IOM, 2001.