Performance Measurement: Accelerating Improvement

383 Pages·2006·1.68 MB·English

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Performance Measurement: Accelerating

Improvement

Committee on Redesigning Health Insurance

Performance Measures, Payment, and� Performance
Improvement Programs

ISBN: 0-309-65325-8, 364 pages, 6 x 9, (2006)

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Performance Measurement: Accelerating Improvement
http://www.nap.edu/catalog/11517.html
Pathways to Quality Health Care
PERFORMANCE
MEASUREMENT
Accelerating Improvement
Committee on Redesigning Health Insurance Performance Measures,
Payment, and Performance Improvement Programs
Board on Health Care Services
Copyright © National Academy of Sciences. All rights reserved.
Performance Measurement: Accelerating Improvement
http://www.nap.edu/catalog/11517.html
THE NATIONAL ACADEMIES PRESS 500 Fifth Street, N.W. Washington, DC 20001
NOTICE: The project that is the subject of this report was approved by the Governing Board
of the National Research Council, whose members are drawn from the councils of the Na-
tional Academy of Sciences, the National Academy of Engineering, and the Institute of Medi-
cine. The members of the committee responsible for the report were chosen for their special
competences and with regard for appropriate balance.
This study was supported by Contract No. HHSM-500-2004-00005C between the National
Academy of Sciences and the U.S. Department of Health and Human Services through the
Centers for Medicare and Medicaid Services. Any opinions, findings, conclusions, or recom-
mendations expressed in this publication are those of the author(s) and do not necessarily
reflect the view of the organizations or agencies that provided support for this project.
Library of Congress Cataloging-in-Publication Data
Performance measurement : accelerating improvement / Committee on
Redesigning Health Insurance Performance Measures, Payment,
and Performance Improvement Programs, Board on Health Care
Services.
p. ; cm. — (Pathways to quality health care)
Includes bibiographical references.
ISBN 0-309-10007-0 (hardback)
1. Medical care—United States—Quality control. 2. Medical care
—Standards—United States. 3. Performance—Measurement.
I. Institute of Medicine (U.S.). Committee on Redesigning Health
Insurance Performance Measures, Payment, and Performance
Improvement Programs. II. Series.
[DNLM: 1. Quality Assurance, Health Care—methods—United
States. 2. Quality of Health Care—standards—United States.
W 84 AA1 P32 2006]
RA399.A3P44 2006
362.1068—dc22
2005037405
Additional copies of this report are available from the National Academies Press, 500 Fifth
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For more information about the Institute of Medicine, visit the IOM home page at:
www.iom.edu.
Copyright 2006 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America.
The serpent has been a symbol of long life, healing, and knowledge among almost all cultures
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Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Mu-
seum in Berlin.
Copyright © National Academy of Sciences. All rights reserved.
Performance Measurement: Accelerating Improvement
http://www.nap.edu/catalog/11517.html
“Knowing is not enough; we must apply.
Willing is not enough; we must do.”
—Goethe
Advising the Nation. Improving Health.
Copyright © National Academy of Sciences. All rights reserved.
Performance Measurement: Accelerating Improvement
http://www.nap.edu/catalog/11517.html
The National Academy of Sciences is a private, nonprofit, self-perpetuating society
of distinguished scholars engaged in scientific and engineering research, dedicated
to the furtherance of science and technology and to their use for the general welfare.
Upon the authority of the charter granted to it by the Congress in 1863, the Acad-
emy has a mandate that requires it to advise the federal government on scientific and
technical matters. Dr. Ralph J. Cicerone is president of the National Academy of
Sciences.
The National Academy of Engineering was established in 1964, under the charter of
the National Academy of Sciences, as a parallel organization of outstanding engi-
neers. It is autonomous in its administration and in the selection of its members,
sharing with the National Academy of Sciences the responsibility for advising the
federal government. The National Academy of Engineering also sponsors engineer-
ing programs aimed at meeting national needs, encourages education and research,
and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is presi-
dent of the National Academy of Engineering.
The Institute of Medicine was established in 1970 by the National Academy of
Sciences to secure the services of eminent members of appropriate professions in the
examination of policy matters pertaining to the health of the public. The Institute
acts under the responsibility given to the National Academy of Sciences by its con-
gressional charter to be an adviser to the federal government and, upon its own
initiative, to identify issues of medical care, research, and education. Dr. Harvey V.
Fineberg is president of the Institute of Medicine.
The National Research Council was organized by the National Academy of Sciences
in 1916 to associate the broad community of science and technology with the
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cil is administered jointly by both Academies and the Institute of Medicine. Dr.
Ralph J. Cicerone and Dr. Wm. A. Wulf are chair and vice chair, respectively, of the
National Research Council.
www.national-academies.org
Copyright © National Academy of Sciences. All rights reserved.
Performance Measurement: Accelerating Improvement
http://www.nap.edu/catalog/11517.html
COMMITTEE ON REDESIGNING HEALTH INSURANCE
PERFORMANCE MEASURES, PAYMENT, AND PERFORMANCE
IMPROVEMENT PROGRAMS
STEVEN A. SCHROEDER (Chair), Distinguished Professor of Health and
Health Care, University of California, San Francisco, CA
BOBBIE BERKOWITZ, Alumni Endowed Professor of Nursing,
Psychosocial and Community Health, University of Washington,
Seattle,WA
DONALD M. BERWICK, President and Chief Executive Officer, Institute
for Healthcare Improvement, Cambridge, MA
BRUCE E. BRADLEY, Director Health Plan Strategy and Public Policy
Health Care Initiatives, General Motors Corporation, Pontiac, MI
JANET M. CORRIGAN,* President and Chief Executive Officer, National
Committee for Quality Health Care, Washington, DC
KAREN DAVIS, President, Commonwealth Fund, New York, NY
NANCY-ANN MIN DEPARLE, Senior Advisor, JP Morgan Partners,
LLC, Washington, DC
ELLIOTT S. FISHER, Professor of Medicine and Community Family
Medicine, Dartmouth Medical School, Hanover, NH
RICHARD G. FRANK, Margaret T. Morris Professor of Health Economics,
Harvard Medical School, Boston, MA
ROBERT S. GALVIN, Corporate Health and Medical Programs, General
Electric Company, Fairfield, CT
DAVID H. GUSTAFSON, Research Professor of Industrial Engineering,
University of Wisconsin, Madison, WI
MARY ANNE KODA-KIMBLE, Professor and Dean, School of Pharmacy,
University of California, San Francisco, CA
ALAN R. NELSON, Special Advisor to the Executive Vice President,
American College of Physicians, Fairfax, VA
NORMAN C. PAYSON, President, NCP, Inc., Concord, NH
WILLIAM A. PECK, Director, Center for Health Policy, Washington
University School of Medicine, St. Louis, MO
NEIL R. POWE, Professor of Medicine, Epidemiology and Health Policy,
Johns Hopkins University School of Medicine and Johns Hopkins
Bloomberg School of Public Health, Baltimore, MD
CHRISTOPHER QUERAM, Chief Executive Officer, Employer Health
Care Alliance Cooperative—The Alliance, Madison, WI
ROBERT D. REISCHAUER, President, The Urban Institute, Washington, DC
WILLIAM C. RICHARDSON, Former President, W.K. Kellogg
Foundation, Battle Creek, MI
*Dr. Corrigan was appointed to the Committee on June 1, 2005.
v
Copyright © National Academy of Sciences. All rights reserved.
Performance Measurement: Accelerating Improvement
http://www.nap.edu/catalog/11517.html
CHERYL M. SCOTT, President Emerita, Group Health Cooperative,
Seattle, WA
STEPHEN M. SHORTELL, Blue Cross of California Distinguished
Professor of Health Policy and Management and Dean, School of Public
Health, University of California, Berkeley, CA
SAMUEL O. THIER, Professor of Medicine and Professor of Health Care
Policy, Harvard Medical School and Massachusetts General Hospital,
Boston, MA
GAIL R. WILENSKY, Senior Fellow, Project HOPE, Bethesda, MD
Study Staff
JANET CORRIGAN, Project Director1
ROSEMARY A. CHALK, Project Director2
KAREN ADAMS, Senior Program Officer, Lead Staff for the Subcommittee
on Performance Measurement Evaluation
DIANNE MILLER WOLMAN, Senior Program Officer, Lead Staff for the
Subcommittee on Quality Improvement Organizations Evaluation
CONTESSA FINCHER, Program Officer3
TRACY HARRIS, Program Officer
SAMANTHA CHAO, Senior Health Policy Associate
DANITZA VALDIVIA, Program Associate
MICHELLE BAZEMORE, Senior Program Assistant
Editorial Consultants
RONA BRIERE, Briere Associates, Inc.
ALISA DECATUR, Briere Associates, Inc.
1Served through May 2005.
2Beginning May 2005.
3Served through July 2005.
vi
Copyright © National Academy of Sciences. All rights reserved.
Performance Measurement: Accelerating Improvement
http://www.nap.edu/catalog/11517.html
Reviewers
This report has been reviewed in draft form by individuals chosen for
their diverse perspectives and technical expertise, in accordance with proce-
dures approved by the National Research Council’s (NRC’s) Report Re-
view Committee. The purpose of this independent review is to provide can-
did and critical comments that will assist the institution in making its
published report as sound as possible and to ensure that the report meets
institutional standards for objectivity, evidence, and responsiveness to the
study charge. The review comments and draft manuscript remain confiden-
tial to protect the integrity of the deliberative process. We wish to thank the
following individuals for their review of this report:
KATHLEEN O. ANGEL, Director of Global Benefits and
International Compensation, Dell Computer Corporation, Round
Rock, TX
ELIZABETH H. BRADLEY, Associate Professor of Public Health and
Director of the Health Management Program in the Division of
Health Policy and Administration, Yale School of Medicine, New
Haven, CT
LINDA BURNES-BOLTON, Vice President and Chief Nursing
Officer, Cedars-Sinai Medical Center, Los Angeles, CA
ROBERT GRAHAM, Professor of Family Medicine and a Robert and
Myfanwy Smith Chair, University of Cincinnati College of
Medicine, OH
STUART GUTERMAN, Senior Program Director of Medicare
Future, Commonwealth Fund, New York, NY
vii
Copyright © National Academy of Sciences. All rights reserved.
Performance Measurement: Accelerating Improvement
http://www.nap.edu/catalog/11517.html
viii REVIEWERS
DAVID A. KNAPP, Dean of the School of Pharmacy, University of
Maryland, Baltimore, MD
STEVE LIPSTEIN, Chief Executive Officer, Barnes Jewish HealthCare,
St. Louis, MO
HAROLD S. LUFT, Director and Caldwell B. Esselstyn Professor of
Health Policy and Health Economics, The Institute of Health Policy
Studies, University of California at San Francisco, San Francisco,
CA
RICARDO MARTINEZ, Executive Vice President of Medical Affairs,
The Schumacher Group, Kennesaw, GA
WALTER ORENSTEIN, Director of Vaccine Policy and Development
and Associate Professor, Emory University School of Medicine,
Atlanta, GA
L. GREGORY PAWLSON, Executive Vice President, National
Committee on Quality Assurance, Washington, DC
PAMELA B. PEELE, Associate Professor and Vice Chair of Health
Policy and Management, Graduate School of Public Health,
University of Pittsburgh, PA
SARA ROSENBAUM, Chair of the Department of Health Policy,
George Washington University, Washington, DC
TIM SIZE, Executive Director, Rural Wisconsin Health Cooperative,
Sauk City, WI
SHOSHANNA SOFAER, Robert P. Luciano Professor of Health Care
Policy, School of Public Affairs, Baruch College, New York, NY
ALAN M. ZASLAVSKY, Professor of Statistics, Department of Health
Care Policy, Harvard Medical School, Boston, MA
Although the reviewers listed above have provided many constructive
comments and suggestions, they were not asked to endorse the conclusions
or recommendations nor did they see the final draft of the report before its
release. The review of this report was overseen by coordinator DONALD
M. STEINWACHS, Ph.D., Professor and Chair, Johns Hopkins Bloomberg
School of Public Health, Baltimore, MD, and monitor HAROLD C. SOX,
M.D., M.A.C.P., Editor, Annals of Internal Medicine, Philadelphia, PA.
Appointed by the NRC, they were responsible for making certain that an
independent examination of this report was carried out in accordance with
institutional procedures and that all review comments were carefully con-
sidered. Responsibility for the final content of this report rests entirely with
the authoring committee and the institution.
Copyright © National Academy of Sciences. All rights reserved.
Performance Measurement: Accelerating Improvement
http://www.nap.edu/catalog/11517.html
Preface
Performance Measurement: Accelerating Improvement is the first in a
new series of reports by the Institute of Medicine (IOM), representing the
latest phase of the ongoing IOM effort on health care quality. This report
introduces a framework and implementation strategy for translating public
and professional concerns about performance and accountability into mea-
sures of health care quality. In so doing, it builds upon central themes ar-
ticulated in earlier IOM reports, including To Err Is Human: Building a
Safer Health System and Crossing the Quality Chasm: A New Health Sys-
tem for the 21st Century. In particular, this report addresses one aspect of
an overall strategy for implementing the six aims of the health care system
articulated in the Quality Chasm report: health care should be safe, effec-
tive, patient-centered, timely, efficient, and equitable.
In its deliberations, the IOM Committee on Redesigning Health Insur-
ance Performance Measures, Payment, and Performance Improvement Pro-
grams was struck by the energy and thoughtfulness displayed in multiple
efforts to create health care quality improvement measures among public
and private stakeholders and throughout the medical profession. These ef-
forts represent important contributions to the development of new stan-
dards of accountability. However, the lack of connections and conceptual
links among the performance measures put forth by different groups has
created an administrative burden for providers, and is a significant barrier
to moving the quality initiative forward to a new stage of development.
The time is ripe, therefore, for an informed national effort to standard-
ize measures that can lay the foundation for a health care incentive system
designed to reward the achievement of the six aims articulated in the Qual-
ix
Copyright © National Academy of Sciences. All rights reserved.