Organizing Quality Measures by Domains of Health Care Quality

Quality information is easier to understand if users have a framework, or mental model, for thinking about health care quality. (Learn more about quality frameworks.) One of the most commonly used frameworks comes from the Institute of Medicine (IOM), which has articulated six aims of health care that many consider to be domains of quality, broadly defined. The IOM says health care should be safe, effective, timely, patient-centered, efficient and equitable.[1] The discussion of available quality measures in the Select Measures section of this site uses this framework; to read this discussion, go to: Measures of Quality for Different Health Care Settings.

In studies with consumers to explore if these terms are understandable and salient, researchers found that potential users of public reports respond well to a simplification of this framework into three categories, or domains, of quality:[2]

  • Care that protects patients from medical errors and does not cause harm (safe)
  • Care that is proven to work or get results (effective; efficient)
  • Care that is responsive to a patient’s needs and preferences (patient-centered, timely, and equitable).

Advantages of Categorizing by Quality Domain

  • We know that consumers respond positively to these categories.
  • It is relatively easy to “map” measures into these categories.
  • This approach reinforces the IOM’s widely accepted framework for quality.

Disadvantages of Categorizing by Quality Domain

  • These categories are relatively unfamiliar to most consumers.
  • If you have a very large number of measures, overall or in one of these three areas, you will probably need to find an additional way to break them into more manageable chunks of information.

EXAMPLE: Organizing Measures by Institute of Medicine (IOM) Quality Domains

Title: Performance and Progress Report
Sponsor: Wisconsin Collaborative for Healthcare Quality (WCHQ)

The Wisconsin Collaborative for Healthcare Quality online reports offer the option of viewing the data categorized by the IOM quality domains.

Source: Wisconsin Collaborative for Healthcare Quality (WCHQ). Performance & Progress Report. Available at

[1] Institute of Medicine (IOM). Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, D.C: National Academy Press; 2001.
[2] Hibbard JH, Greene J, Daniel D, Rabson B, Lambiosa B. Giving Consumers a Framework for Understanding Quality. Presentation delivered at the Annual Meeting of the Aligning Forces for Quality initiative, sponsored by the Robert Wood Johnson Foundation. Chicago, IL. May 2009.

Also in "Organizing Measures To Reduce Information Overload"

Page last reviewed March 2016
Page originally created February 2015
Internet Citation: Organizing Quality Measures by Domains of Health Care Quality. Content last reviewed March 2016. Agency for Healthcare Research and Quality, Rockville, MD.
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