President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry

Establishing Health Care Quality as a National Priority

Chapter Four
Advancing Quality Measurement and Reporting

Establishing national aims for improvement alone will not lead to better quality health care. Standardized measures of quality are needed to track the health care industry's progress in reaching the aims established for the Nation and to guide public health planning and policy making. Comparative information on quality also is needed for individual consumers, group purchasers, and others to use in selecting health care providers and health plans. Furthermore, valid and stable quality measures are integral to health plans' and providers' efforts to improve performance, and, when standardized, encourage health care organizations to learn from each other through a process of benchmarking.

Despite a growing number of efforts to measure and report on health care quality, useful information is neither uniformly nor widely available. Improving our ability to measure quality has been the object of significant public and private sector activity over the last decade, reflecting the expectation that measurement can serve both as a catalyst and a tool for improvement. While considerable advancements have been made in the quality measurement field in recent years, current efforts fall short of fully meeting users' needs, and often are duplicative and unduly burdensome on health care providers, plans, and others.

The Commission has identified several steps critical to advancement. First, core sets of standardized quality measures should be identified to address the common information needs of individual consumers, group purchasers, health plans and providers, oversight organizations, and public health and policy officials. These measures must focus on areas that can have a meaningful impact on the quality of health care and be consistent with national aims for improvement. In addition, new and better quality measures should be developed to fill important gaps in existing measurement sets, and steps should be taken to ensure that comparative information on health care quality is valid, reliable, meaningful, comprehensible, and widely available through multiple means of dissemination.


Quality Measurement Is a Critical Tool

Measurement is a critical tool for improving quality and for supplying the information consumers and purchasers need in a market-driven health system. A large and growing number of health care quality measurement and reporting initiatives have recently been developed in an effort to address the demand for information.

Core Sets of Quality Measures Needed

Existing mechanisms for quality measurement and reporting do not fully meet the needs of the potential users of information on health care quality. Despite recent development of improved measures, initiation of new measurement efforts, and advancements in methodology, information that can be used by consumers, group purchasers, and others to make health care choices is neither widely nor uniformly available (see Chapter 6 and Chapter 7).

Nor do current measurement initiatives serve public health and quality improvement objectives as well as they might. Incentives to improve quality have been diluted by measurement efforts that vary widely in their aims and scope, and that have been, at best, only informally coordinated. A lack of clearly articulated national priorities for improving health care quality has meant that the superior ability to measure quality in specific areas or along certain dimensions may have diverted attention from issues of greater importance with respect to quality.

Furthermore, the lack of widely agreed-upon priorities and standards for quality measurement has been a source of frustration and inefficiency. Most health plans and providers now produce data in response to multiple, customized requests from purchasers, oversight bodies, consumer groups, and others. For example, a health plan might be required to calculate and report on how it cares for individuals with diabetes in several different ways to respond to uncoordinated demands. Similarly, a health care practitioner who participates in several health plans may need to fulfill various requests for data of different types and formulations. The resulting information is not always comparable, meaningful, valid, or reliable, and is disseminated in different ways and through various means.

To increase the effectiveness and efficiency of measurement, core sets of quality measures for each sector of the health care industry should be identified for reporting in a standardized way. Measurement sets should be designed to meet the information needs of potential audiences and should reflect defined national aims for improvement in health care (see Chapter 3). In this way, their development would ensure the availability of comparable information on quality and increase the potential impact of measurement while alleviating the burden of complying with reporting requests. Developing standards for measuring and reporting on a core set of indicators also would allow health care providers and organizations to reallocate resources to focused quality improvement and to the generation of additional information, as needed, to supplement the core measures. Finally, core measurement sets would assist in tracking progress in addressing high-priority areas established as national aims for quality improvement.

A Framework for Quality Measurement and Reporting

Prior to and concurrent with the identification of core measurement sets, a framework for measurement and reporting must be developed. A key part of that effort will be to articulate a strategy for quality measurement and reporting to make the results of comparative quality measurement available in the public domain. Other steps are also needed to increase the effectiveness and efficiency of quality measurement. For instance, measurement priorities must be identified, credible and open processes for specifying core sets of measures must be implemented, policy issues associated with measurement and reporting must be addressed, and public understanding of the value and use of quality measures must be advanced. There is also a need to encourage widespread compliance with the measurement and reporting specifications identified and to build capacity for quality measurement and reporting across the industry.

Increasing Quality Measurement Capabilities

For quality measurement efforts to achieve the aims that have been set for them, they must better meet the needs of those who would use the information they generate. While considerable advancements have been made in the quality measurement field in recent years, current efforts fall short of fully meeting users' needs. Several elements are critical to advancement. New and better quality measures are needed to fill important gaps in existing measurement sets, and improved approaches are needed to fully utilize existing measures. Steps should be taken to ensure that comparative information on health care quality is valid, reliable, comprehensible, and widely available. Perhaps most important, a significant investment in data collection, database management, and information systems must be undertaken to support improved health care quality measurement initiatives (see Chapter 14).


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Udvarhelyi, Steven, oral testimony before the joint Subcommittees of the Advisory Commission on Consumer Protection and Quality in the Health Care Industry, June 25, 1997.

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Last Revised: Sunday, July 19, 1998