Health Care Quality Frequently Asked Questions
Question: What is meant by health care quality?
Answer:
The U.S. Institute of Medicine (IOM) defines "quality" as: the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge. IOM released the report, "Crossing the Quality Chasm: A New Health System for the 21st Century" calling for fundamental reform of the U.S. health care system. This report identified six aims for health care quality improvement: safe, effective, patient-centered, timely, efficient, and equitable.
Question: Who monitors the quality of care given by health care providers?
Answer:
There are several organizations that monitor health care providers and others that set the standards for quality health care. Some organizations will do both. The major health care quality organizations include from the public sector: the Quality Improvement Organizations and the Centers for Medicare and Medicaid Services (CMS) and from the private sector: The Joint Commission, Leapfrog Group, the Institute for Safe Medication Practices, the National Center for Healthcare Leadership, the National Coalition for Health Care, and the National Committee for Quality Assurance.
Private health plans also monitor quality health care. According to a recent National Committee for Quality Assurance (NCOA) report a combination of performance measurement and public reporting by private health plans can save tens of thousands of lives and billions of dollars every year. Data in the NCQA's State of Health Care Quality 2006 report show that more than 76 million American patients who are enrolled in a private plan saw clinical improvement in 35 of 42 performance measures. These patients are more likely to receive preventive care and have their chronic conditions managed in accordance with clinical guidelines.
Question: What are the standards of care by which quality is measured?
Answer:
The 2006 National Healthcare Quality Report (NHQR) is an Agency for Healthcare Research and Quality (AHRQ)-led effort on behalf of the U.S. Department of Health and Human Services. This is the third annual NHQR report which extends the work from the 2003 and 2004 reports. It is built on a set of health care quality standards or measures across four dimensions of quality - effectiveness of care, patient safety, timeliness, and patient centeredness - and, within the effectiveness component, nine clinical condition areas or care settings - cancer, diabetes, end stage renal disease, heart disease, HIV/AIDS, maternal and child health, mental health and substance abuse, respiratory diseases, and nursing home and home health care.
The 2006 NHQR List of Measures are found in the latter section of this report.
The National Quality Forum (NQF) Safe Practices for Better Healthcare report details 30 healthcare
practices that should be universally utilized in clinical care
settings to reduce the risk of harm to patients. The full report is available from the National Quality Forum and the NQF Safe Practices for Better Healthcare: Summary is available online.
Question: How can I find out about how well our state is doing regarding health care quality?
Answer:
The Agency for Healthcare Research and Quality using data from the National Healthcare Quality Reports develops lists of performance measures that can be used to monitor the Nation's progress toward improved health care quality for all Americans. This annual national report shows the rankings of states on these measures and compares states to national averages on each of the selected measures. In addition a State Snapshot series based on the most current National Healthcare Quality Report, 2006 provides state-specific health care quality information depicting strengths, weaknesses, and opportunities for improvements for each state.
Question: Where can I find additional information about health care quality measurement?
Answer:
The National Quality Measures Clearinghouse sponsored by the Agency for Healthcare Research and Quality is a database and Web site for information on specific evidence-based health care quality measures and measure sets.
Question: What is being done to address the quality challenges in rural communities?
Answer: The IOM in their report, "Quality Through Collaboration: The Future of Rural Health Care" identified a five point strategy to address the quality challenges in rural communities:
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Adopt an integrated, prioritized approach to addressing both personal and population health needs at the community level;
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Establish a stronger quality improvement support structure to assist rural health systems and professionals in acquiring knowledge and tools to improve quality;
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Enhance the human resource capacity of rural communities, including the education, training, and deployment of health care professionals, and the preparedness of rural residents to engage actively in improving their health and health care;
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Monitor rural health care systems to ensure that they are financially stable and provide assistance in securing the necessary capital for system redesign; and
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Invest in building an
information and communications technology
(ICT) infrastructure, which has enormous potential to enhance health and health care over the coming decades.
Question: How would one choose a quality health care provider?
Answer: Information regarding the selection of a quality health care provider is available from the Agency for Healthcare Research and Quality. This agency developed a document titled: Your Guide to Choosing Quality Health Care to help consumers choose the best health care provider for them.
Question: How do I register a concern or a complaint about a health care organization?
Answer:
Write to the Office of Quality Monitoring at the Joint Commission, One Renaissance Blvd., Oakbrook Terrace, IL 60181. You can also print a Quality Incident Report Form to mail, or fax to 630-792-5636. For more information, please call 800-994-6610. Also, you may direct your concerns to your state Quality Improvement Organization.
Question: Where can consumers obtain information about the quality of health care in their community?
Answer: The Centers for Medicare and Medicaid Services (CMS) has consumer information available on care quality for nursing homes (Nursing Home Compare), home health (Home Health Compare) and most recently, hospitals (Hospital Compare). These free information sources rate facilities on sets of health care quality measures and include providers that participate in the Medicare program. For example, the quality measures for hospitals, by using information from patient records, show how well hospitals provide care for three types of illness; pneumonia, heart failure, heart attack. The CMS intends to improve and expand these resources based on the belief that informed consumers will choose care from settings that provide high quality.
Information is also available from private sector reporting systems such as the Leapfrog Group and the Consumer Assessment of Healthcare Providers and Systems (CAHPS) program which reports on patient safety practices in hospitals.
Question: Is there research that focuses specifically on rural health care quality?
Answer: The federal Office of Rural Health Policy (ORHP) supports a number of rural health research centers that conduct a variety of research, including studies of rural health care quality. The Rural Assistance Center has a Rural Health Research Center Publications section on their web site that lists a variety of publications produced by ORHP funded research centers as well as other useful documents and bibliographies. The Journal of Rural Health devoted an entire issue (October 2004) to articles about rural health care quality.
Question: How is health care quality assured?
Answer: State regulatory agencies license health care providers. They also survey and certify health care organizations to ensure the delivery of safe care. Additionally, CMS surveys and certifies health care facilities for compliance with their quality standards. Health care facilities can voluntarily choose to be reviewed for accreditation which indicates that they meet performance standards set by an external organization (e.g., the Joint Commission accreditation of hospitals). To participate in the Medicare program, hospitals must be accredited by the Joint Commission or federally certified. Rural hospitals are less likely to seek accreditation than their urban counterparts and often choose instead to be federally certified through state survey processes.
Question: Are all hospitals required to report to CMS on quality measures in order to maximize their reimbursement through the Medicare program?
Answer: No, critical access hospitals (CAHs) can voluntarily report to CMS but it does not affect their reimbursement. All hospitals paid through the prospective payment system are required to report in order to maximize their reimbursement.
Question: What activities are underway to link pay-for-performance as a strategy to encourage the delivery of high quality care?
Answer: Both public sector (e.g., CMS) and private sector organizations (e.g., Aetna, Blue Cross and Blue Shield) are pursuing pay-for-performance strategies to drive improved quality. One of the major public sector efforts underway was integrated in the Medicare Modernization Act (2003) that established financial incentives for hospitals that provide data on quality indicators.
Question: What is the role of health information technology (HIT) in achieving high quality health care in rural communities?
Answer: HIT involves the application of computer technology to generate, validate, secure and integrate healthcare data so it can be effectively utilized to support the decision-making activities of clinical and administrative professionals.
HIT applications provide; immediate access to patient information, care guidelines for clinicians, and health services that transcend geographic distances. Computerized drug order entry systems and electronic medical records have shown to decrease error and improve quality of patient care.
Question: Does public reporting on quality disadvantage rural hospitals and other low volume rural facilities?
Answer:
Significant concern has been expressed regarding the ability of rural hospitals to meaningfully report, given their low volume. That is, if there are only a few cases of a particular disease (e.g., heart failure), then one outcome that reflects poor quality care (small sample size) can have a distorted impact on the rates that are reported to the public. Additionally, rural health care providers have expressed concern that the indicators being reported are not always reflective of the type of care provided in small rural facilities (e.g., measures of intensive care as opposed to measures of transferring patients from rural to urban facilities).
Credits
Last revised 10/24/2007
