Building consensus on what really counts
Iam often asked to address the challenges that the growth of measurement and accountability requirements pose for the important goal of healthcare quality improvement. My thinking here has evolved over time.
The field has grown tremendously since 1998, when the President’s Advisory Commission on Consumer Protection and Quality in the Health Care Industry, on which I served, recommended the creation of the National Quality Forum. We have come a long way in 15 years, from a time when there were too few quality measures, to a time when numerous observers think there are too many.
In 1999, when the NQF—the multistakeholder group that reviews and endorses measures used to assess performance—began its work, there were just a few standardized quality measures in limited use.
There are now more than 600 NQF-endorsed measures on a wide range of issues, from reducing hospital-acquired infections, to providing better care for mothers and babies, to improving treatment for chronic conditions such as diabetes. We’re now hard at work on the next challenge: bringing healthcare stakeholders together to identify a small group of high-impact, high-leverage core measures for providers to broadly use, publicly report and link to payment.
Initial expansion of measurement criteria was a necessary step in an evolving quality-improvement landscape. However, the proliferation of measures has made it tough for providers to keep up with reporting requirements, while creating confusion for patients. By forging an agreement about the most useful measures and interventions, we can reduce reporting burdens, hasten improvements and give patients comparable information to make informed decisions.
For example, in January 2012 the NQF convened a group that included the American College of Obstetricians and Gynecologists, the American Hospital Association, the Joint Commission and the March of Dimes to agree on a standardized quality-improvement intervention and measures to reduce harmful, costly, early elective deliveries. Nationwide, those deliveries decreased by half between 2012 and 2013.
I’m proud of the tremendous growth and evolution of quality measurement since 1999 and invite others to join me in tackling the next big challenge: building consensus around measures and interventions that improve patient care and the health of all Americans. To get that right, we need everyone at the table, focused on the value of one goal: better care at lower cost.
Dr. Christine Cassel is president and CEO of the National Quality Forum, Washington.