HSI Quality Measurement Intro factsheet final web

Transcript

1 / Evidence Generation Measuring Health Care Quality: Health System Improvement An Introduction Measuring the quality of Too often, the quality of care that is provided in the What is quality health care, and why United States is substandard: Patients receive the proper health care can shed light is measuring health care quality 3 diagnosis and care only about 55 percent of the time; on how the health system important? and wide variations in health care quality, access, and performs and improve We need to improve the quality of our nation’s health 4 outcomes persist. Research consistently shows that care. It can also help hold care, and the first step in that process is measuring the there is chronic underuse, overuse, and misuse of health health care providers and quality of care that is currently provided. care services. These failures can lead to serious harm— health plans accountable for or even death. What does “quality health care” mean? providing high-quality care, address disparities in health Furthermore, the way health care is delivered in this Quality health care is “the right care for the right 1 country is often fragmented, overly complex, and care, and help consumers person at the right time, the first time.” The Institute of uncoordinated, all of which can have a negative impact Medicine has identified six aspects of high-quality care. make informed choices. on patient health. Health care should be safe, timely, effective, efficient, 2 equitable, and patient-centered. How do we measure health care quality? Why is measuring health care quality so Quality measurement in health care uses data to evaluate important? the performance of health care providers against Americans pay more for health care per person than recognized quality standards. We can measure quality in residents of any other country. However, there is many different ways, and these measures evaluate care little evidence to suggest that this higher spending across the full range of health care settings (including has produced better care. doctors’ offices, imaging facilities, and hospitals). WWW.FAMILIESUSA.ORG FACT SHEET / MARCH 2014

2 and/or misuse of health care services (also known How can quality measurement 5 as medical errors). Overuse of tests or procedures improve health care? that are not medically required can also endanger Quality measurement is a critical tool that can be used patients’ health, and it increases health care costs, to improve care in several ways: resulting in wasteful spending. 1. preventing the overuse, underuse, and misuse of Implementing appropriate quality measures is essential health care services and ensuring patient safety to getting every patient the right care at the right time 2. identifying what works in health care—and what and never more care than is needed. And strong quality doesn’t—to drive improvement measurement is a critical tool for ensuring patient safety while improving patient health. holding health insurance plans and health care 3. providers accountable for providing high-quality care 2. Identifying what works in health care—and what doesn’t—to drive improvement measuring and addressing disparities in how care 4. If we don’t measure the quality of the health care that is delivered and in health outcomes is delivered to patients, we won’t know what kinds of 5. helping consumers make informed choices about improvements are needed or where they are needed. their care Measuring health care quality is critical to assessing the We discuss each of these improvements below. performance of the health care system and evaluating patients’ experience of care. But measuring quality is 1. Preventing the overuse, underuse, and misuse also necessary to identify where the health care system of health care and ensuring patient safety falls short. Every year, the health of millions of Americans is endangered because they do not receive The Affordable Care Act has introduced several policies necessary care (underuse), they receive care that is that are changing how health care providers are paid unnecessary (overuse), or they receive the wrong and how health care is delivered, and the health care care for their needs (misuse). The underuse or system is changing significantly as a result. The use misuse of medical care can lead to preventable of quality measurement is essential to ensuring that complications, illness, or even death: An estimated these changes actually improve the quality of care, or 98,000 people die each year due to the underuse at the very least, maintain it. MEASURING HEALTH CARE QUALITY: AN INTRODUCTION 2

3 policymakers the information they need to develop 3. Holding health insurance plans and health care providers accountable for providing high- targeted improvements in health care for those who Key Term quality care need them the most. It will also allow policymakers to Acc reditation: Recognition Measuring health care quality makes it possible to hold providers accountable for providing quality care granted to an institution (such hold health insurance plans and health care providers to all populations. as a health care provider or accountable for the quality of the care and services they health plan) by a professional Tailoring quality measurement to the particular care provide. This accountability can take many forms. For association or non-governmental needs of different demographic groups is one potential example: agency demonstrating that the strategy to addressing disparities in the of quality care institution meets pre-established A health plan might need to demonstrate a » and to ensuring that all patients get the care they need standards. certain level of performance or risk losing its when they need it. In this regard, quality measurement . accreditation can help speed the pace at which providers integrate new research findings into practice. Hospitals could be required to publicly report their » performance on select quality measures, and if they perform poorly, they may lose business as a result. Access and Quality: Two Sides of the Same Coin Providers may face financial penalties or have » payment bonuses withheld if they cannot meet The Affordable Care Act has expanded health certain quality benchmarks. insurance to millions of previously uninsured Americans. However, having an insurance card These forms of accountability can help ensure that does not guarantee that consumers will have the changes made to our health care system improve access to the care they need when they need patients’ health and their experience of health care. it, nor does it guarantee that their care will be high-quality. Quality measurement is essential 4. Measuring and addressing disparities in how to ensuring that having health insurance also care is delivered and in health outcomes means having access to a health care system that Racial and ethnic minorities and low-income consistently delivers high-quality care and that Americans routinely face more barriers to care and is responsive to consumers’ needs, values, and 6 receive poorer-quality care. Measuring the quality preferences. of care that is delivered to diverse groups will give MEASURING HEALTH CARE QUALITY: AN INTRODUCTION 3

4 5. Helping consumers make informed choices Endnotes about their care 1 Transcript of remarks by Carolyn Clancy, Measuring Health Care Consumers face a bewildering array of decisions about (Washington: Kaiser Family Foundation, 2008), available Quality online at . http://kff.org/archived-kaiseredu-org-tutorials/ health care, ranging from which health plan to select to which provider to see within a primary care practice. Crossing the Quality Chasm 2 The Institute of Medicine, (Washington: http://www. National Academy of Sciences, 2001), available online at Quality measures can give consumers important iom.edu/~/media/Files/Report%20Files/2001/Crossing-the-Quality- information they need to make health care decisions. . Chasm/Quality%20Chasm%202001%20%20report%20brief.pdf Patient-centered care is care that is responsive to consumers’ needs, In the past, information about critical quality issues values, and preferences. either did not exist or was not made available to 3 Elizabeth McGlynn, Stephen Asch, John Adams, et al., “The Quality consumers, which meant that they did not have access The New England of Care Delivered to Adults in the United States,” to all the information they needed to make informed 348, no. 26 (June 2003): 2,641, available online Journal of Medicine decisions. Although quality measurement has become . at http://www.nejm.org/doi/full/10.1056/NEJMsa022615 more commonplace, information on quality is still too 4 Agency for Healthcare Research and Quality, 2012 National Health often not made public or is not available in a format that Care Quality Report (Rockville, MD: Department of Health and Human http://www.ahrq.gov/ Services, May 2013), available online at is easy for consumers to understand. . research/findings/nhqrdr/nhqr12/2012nhqr.pdf Reporting of quality data in ways that are easy for To Err Is Human 5 The Institute of Medicine, (Washington: National consumers to understand is essential to ensuring that http:// Academy of Sciences, November 1999), available online at patients are active and engaged participants in their care. www.iom.edu/~/media/Files/Report%20Files/1999/To-Err-is- Human/To%20Err%20is%20Human%201999%20%20report%20 Recent changes to the way data on quality are reported, . brief.pdf including new provisions in the Affordable Care Act, will 6 Agency for Healthcare Research and Quality, op. cit. accelerate consumers’ access to information on quality and help them identify their best health care options. Quality measurement is essential to ensuring that having health insurance also means having access to a health care system that consistently delivers high-quality care and that is responsive to consumers’ needs, values, and preferences. MEASURING HEALTH CARE QUALITY: AN INTRODUCTION 4

5 Publication ID: 018HSI031914 A selected list of relevant publications to date: This publication was written by: Principles for Consumer-Friendly Value-Based Senior Health Policy Caitlin Morris, Insurance Design (December 2013) Analyst, Families USA Key Differences between Wellness Reward/ Research Director, Kim Bailey, Penalty Programs and Value-Based Insurance Families USA Design (October 2013) The following Families USA staff Shared Decision Making: Engaging Patients to contributed to the preparation of this Improve Care (May 2013) material (listed alphabetically): Evan Potler, Art Director For a more current list, visit: Carla Uriona, Director of Content Strategy www.familiesusa.org/publications Ingrid VanTuinen, Director of Editorial © Families USA 2014 1201 New York Avenue NW, Suite 1100 Washington, DC 20005 202-628-3030 [email protected] www.FamiliesUSA.org facebook / FamiliesUSA twitter / @FamiliesUSA

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