The Issue
Two attempts to systematically measure the quality of health care—one international in scope and one U.S.-focused, are compared and contrasted in this Commonwealth Fund–supported study.
The Health Care Quality Indicators Project, sponsored by the Organization for Economic Cooperation and Development, is the only ongoing international effort to measure quality of care for an array of medical conditions (e.g., cancer, diabetes, and cardiovascular disease) and across a range of quality dimensions (e.g., effectiveness and patient safety) and patient needs (e.g., preventive health, curative care, and coping with the end of life).
Development of the National Healthcare Quality Report, sponsored by the U.S. Agency for Healthcare Research and Quality, offers a set of consensus-based measures of effectiveness, safety, timeliness, and patient-centeredness. The report covers nine clinical conditions, ranging from cancer and heart disease to HIV/AIDS, mental health, and nursing home care.
What the Study Found
Based on their review, the authors draw several lessons for other health care quality reporting efforts at the national and international levels:
- conceptual frameworks are needed to guide indicator selection;
- an early decision must be made to focus either on a wide range of clinical conditions or on a few priority areas;
- methods should be developed to add and take away indicators over time, while still maintaining a core set to track trends;
- resources are needed to communicate results to diverse audiences; and
- mechanisms are needed to maintain the momentum of the effort.
Conclusions
Quality measurement projects face challenges even after the initial launch of a report, including "the choice among using indicators for which there are available data versus developing new indicators" and the need to make "the project useful for quality improvement efforts of national and international scope."