"Performance measures are a fundamental building block for all quality improvement initiatives," said committee chair Steven Schroeder, professor of health and health care, University of California, San Francisco. "One of the biggest obstacles to overcoming shortfalls in the quality of health care is the absence of a coherent, national system for assessing and reporting on the performance of providers and organizations. Leadership at the federal level is necessary to ensure that the effort to develop performance measures achieves overarching national goals for health care improvement."
Improving quality of care has become a top priority for all stakeholders in the health care system. Performance measures are benchmarks by which health care providers and organizations can determine their success in delivering care – for example, regular blood and urine tests for diabetic patients, a facility's 30-day survival rate among cardiac bypass patients, or perceptions of care collected from patient surveys.
Many individual public and private organizations – including health plans, professional organizations, and consumer advocates – have made substantial progress developing measures that cover important areas of clinical care, organizational performance, and patients' perceptions of care. But these independent initiatives have led to duplication in some areas and neglect in others that are important to national health goals, the committee noted. Individual stakeholders understandably focus on certain features of care that they consider to be the highest priority for improvement. But they frequently overlook areas of national interest that are difficult to quantify, such as whether care is equitable, efficient, and well-coordinated.
The new National Quality Coordination Board recommended by the committee should guide and organize efforts to build upon existing initiatives to develop performance measures. As an initial step toward achieving a universally accepted set of measures, the report recommends the immediate adoption of an evidence-based starter set of existing measures that would cover care delivered in ambulatory, acute care, and long-term care settings and in dialysis centers. The board should also guide the development of performance measures for areas that currently lack them, such as efficiency, equity, and patient-centered care.
Congress should authorize $100 million to $200 million in annual funding for the National Quality Coordination Board from the Medicare Trust Fund, the report says. This amounts to less than one-tenth of 1 percent of annual Medicare expenditures.
The proposed board should report directly to the HHS secretary, and its members should be appointed to staggered terms by the president. The board should work with organizations already involved in developing measurement and reporting tools, but it also should be free to contract with other groups to meet its objectives. It should provide Congress with an annual report on its activities and progress.
The HHS secretary should direct the department's agencies and encourage other federal health agencies to focus on achieving the goals established by the National Quality Coordination Board. Also, the Centers for Medicare and Medicaid Services should require providers participating in these programs to submit performance data to the board; the Centers can use this information for quality improvement activities or as a basis for payment incentives and public reporting.
Requested by Congress, this report is the first in a series that will focus on the redesign of health insurance to accelerate the pace of quality improvement efforts in the United States. Subsequent reports will evaluate Medicare's Quality Improvement Organization program and analyze payment incentives.
The study was sponsored by the U.S. Department of Health and Human Services. The Institute of Medicine is a private, nonprofit institution that provides health policy advice under a congressional charter granted to the National Academy of Sciences. A committee roster follows.
Contacts: Christine Stencel, Media Relations Officer Chris Dobbins, Media Relations Assistant Office of News and Public Information 202-334-2138; e-mail <news@nas.edu>
Copies of PERFORMANCE MEASUREMENT: ACCELERATING IMPROVEMENT will be available this winter from the National Academies Press; tel. 202-334-3313 or 1-800-624-6242 or on the Internet at http://www.nap.edu. Reporters may obtain a pre-publication copy from the Office of News and Public Information (contacts listed above).
[ This news release and report are available at http://national-academies.org ]
INSTITUTE OF MEDICINE
Board on Health Care Services
COMMITTEE ON REDESIGNING HEALTH INSURANCE PERFORMANCE MEASURES,
PAYMENT, AND PERFORMANCE IMPROVEMENT PROGRAMS
STEVEN A. SCHROEDER, M.D. (CHAIR)
Distinguished Professor of Health and Health Care
University of California
San Francisco
BOBBIE BERKOWITZ, PH.D., R.N., F.A.A.N.
Alumni Endowed Professor of Nursing, and Psychosocial and Community Health
University of Washington
Seattle
DONALD M. BERWICK, M.D., M.P.P.
President and Chief Executive Officer
Institute for Healthcare Improvement
Cambridge, Mass.
BRUCE E. BRADLEY, M.B.A.
Director, Health Plan Strategy and Public Policy Health Care Initiatives
General Motors Corp.
Pontiac, Mich.
JANET M. CORRIGAN, PH.D.
President and Chief Executive Officer
National Committee for Quality Health Care
Washington, D.C.
KAREN DAVIS, PH.D.
President
Commonwealth Fund
New York City
NANCY-ANN MIN DEPARLE, J.D.
Senior Adviser
J.P. Morgan Partners LLC
Washington, D.C.
ELLIOTT S. FISHER, M.D., M.P.H.
Professor of Medicine and Community Family Medicine
Dartmouth Medical School
Hanover, N.H.
RICHARD G. FRANK, PH.D.
Margaret T. Morris Professor of Health Economics
Harvard Medical School
Boston
ROBERT S. GALVIN, M.D.
Director
Corporate Health and Medical Programs
General Electric Co.
Fairfield, Conn.
DAVID H. GUSTAFSON, PH.D.
Research Professor of Industrial Engineering
University of Wisconsin
Madison
MARY ANNE KODA-KIMBLE, PHARM.D.
Professor and Dean
School of Pharmacy
University of California
San Francisco
ALAN R. NELSON, M.D.
Special Adviser to the Executive Vice President
American College of Physicians
Fairfax, Va.
NORMAN C. PAYSON, M.D.
President
NCP Inc.
Concord, N.H.
WILLIAM A. PECK, M.D.
Director
Center for Health Policy
Washington University School of Medicine
St. Louis
NEIL R. POWE, M.D., M.P.H., M.B.A.
Professor of Medicine, Epidemiology, and Health Policy
Johns Hopkins University School of Medicine and Bloomberg School of Public Health
Baltimore
CHRISTOPHER QUERAM, M.H.A.
Chief Executive Officer
Employer Health Care Alliance Cooperative
Madison, Wisc.
ROBERT D. REISCHAUER, PH.D.
President
Urban Institute
Washington, D.C.
WILLIAM C. RICHARDSON, PH.D.
President and Chief Executive Officer
W.K. Kellogg Foundation
Battle Creek, Mich.
CHERYL M. SCOTT, M.H.A.
President Emerita
Group Health Cooperative
Seattle
STEPHEN M. SHORTELL, PH.D.
Blue Cross of California Distinguished Professor of Health Policy and Management, and
Dean
School of Public Health
University of California
Berkeley
SAMUEL O. THIER, M.D.
Professor of Medicine and Professor of Health Care Policy
Harvard Medical School and Massachusetts General Hospital
Boston
GAIL R. WILENSKY, PH.D.
Senior Fellow
Project HOPE
Bethesda, Md.
INSTITUTE STAFF
ROSEMARY CHALK
Study Director
KAREN ADAMS, PH.D.
Senior Program Officer