Signs of progress in healthcare quality

Regardless of one’s politics, everyone agrees that the amount the government spends on healthcare is certainly no bargain. Another recent study ranked the United States last among 11 industrialized nations for healthcare performance, even though we spend substantially more per patient than other countries that are considered our peers.

Despite these grim statistics—and differences in opinion about the path forward—most members of Congress agree that we can’t improve healthcare if we don’t measure the care that’s being provided.

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In recent years, government funding for healthcare programs has included support for ongoing work to identify and endorse the best measures for clinicians to use to assess and improve care, and provide private-sector input on which measures to use to support 23 federal programs. Policymakers need these measures in order to assess whether various strategies—including payment and delivery system reforms, consumer-directed health plans, and public reporting of provider performance—are actually improving quality and reducing costs.

Much of the work to identify and endorse the best healthcare quality measures is led by the National Quality Forum, an independent scientific organization comprised of members from throughout the healthcare sector, including consumers. NQF fosters discussion and builds consensus among many stakeholders, including the public and private sectors. Working together, they define priorities for quality improvement and reach agreement on measures to help achieve them. Since NQF engages both public and private sector healthcare leaders, it is able to align the measures and strengthen the quality of the information consumers and purchasers can get.

For 15 years NQF has reviewed and endorsed hundreds of quality measures that are now used by public and private payers to measure quality of care, patient experience and costs---and kept those measures up to date with current evidence, retiring those that are no longer useful or accurate.

The investment is paying off. The Centers for Disease Control and Prevention, for example, reported a 58 percent reduction over eight years in certain bloodstream infections due to the use of NQF-developed performance measures and subsequent changes in care. This represents up to 6,000 lives and approximately $1.8 billion saved. Other measures and related changes in how care is delivered are leading to healthier babies, better-managed chronic care and reduced hospital readmissions.

But there is still considerable work ahead. NQF is streamlining its processes to review and endorse better measures faster for use in both federal and private programs that stress performance improvement and accountability. NQF’s endorsement cycle has been reduced from 12 to seven months. We’re also tackling complex issues that pertain to the science of measurement, and forging consensus on topics where there is not always clear agreement among stakeholders, such as how to measure cost and resource use, and whether measures should be adjusted for a patient’s socio-demographic factors, and how to measure hospital readmission rates.    

Healthcare in America will only improve if measurement leads to effective interventions that improve clinician performance, which is then recognized and rewarded. Progress is being made, but the pace of improvement needs to dramatically quicken. We know, however, that measurement is an important accelerant. That is a point upon which all parties agree.  

Cassel is president and CEO of the National Quality Forum, Washington, DC. Learn more at www.qualityforum.org.

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