Strengthening the Health Care Safety Net

National Quality Report

Presenter: Thomas Reilly, Ph.D., Manager, National Quality Report, Center for Quality Measurement and Improvement, Agency for Healthcare Research and Quality (AHRQ), Rockville, MD.

The National Quality Report was mandated by the Healthcare Research and Quality Act of 1999 and was endorsed by the President's Advisory Commission on Consumer Protection and Quality in the Healthcare Industry and the Secretary of the Department of Health and Human Services Quality Improvement Initiative (SQII). This initiative will become integrated with other data-reporting efforts such as Healthy People 2010 and medical errors data collection.

Dr. Reilly described a number of potential uses for the National Quality Report, including to:

• Inform Congress, providers, and consumers about the state of health care quality in the Nation.
• Serve as a barometer of quality to track progress over time.
• Report on system performance and identify areas for improvement.
• Provide national benchmarks for others looking at quality initiatives.

The current status of this project involves developing the framework for:

• Reporting.
• Establishing measures.
• Identifying data sources.
• Conducting market research.
• Coordinating with related efforts.

The preliminary framework includes a matrix of dimensions of care and patient needs. Dimensions of care include:

• Safety.
• Effectiveness.
• Focus on patient.
• Timeliness.
• Efficiency.
• Equity.

Types of care needed by patients include:

• Preventive.
• Acute.
• Chronic.
• Long-term.

Dr. Reilly explained that establishing measures involves identifying and evaluating candidate measures as well as identifying gaps to help define a future research agenda in quality measurement. The project plans to apply several evaluation criteria such as whether the measure is:

• Objectively based on substantial research.
• Relevant to intended audiences.
• Scientifically sound.
• Derived from national data.
• Amenable to subgroup analysis.

AHRQ will identify existing Federal databases such as the Medical Expenditure Panel Survey (MEPS) and the Consumer Assessment of Health Plans (CAHPS®) that might be used to support the National Quality Report in the first year. Dr. Reilly described AHRQ's plans to examine the feasibility of modifying existing data sources and to identify relevant State and private data sources. Other types of data collection efforts under consideration include population-based data, provider-based data such as the Healthcare Cost Utilization Project (HCUP), administrative/regulatory data such as the Health Care Financing Administration's (HCFA) claims data for Medicare and Medicaid, vital statistics, and surveillance data.

The purpose of market research is to identify the needs of potential audiences and design reporting products to meet those needs. Reporting products will include written reports to Congress and a Web-based reporting system. Current market research activities include compiling an inventory of similar reporting projects with regard to quality monitoring, reporting and obtaining feedback from potential audiences.

Coordination of this effort includes AHRQ and SQII workgroups, the Quality Interagency Coordination Task Force (QuIC), external consultation, and international collaboration.

Dr. Reilly summarized that the National Quality Report will provide information to policymakers to monitor the Nation's progress toward improved health care quality. The report is in its early design phase with the first report due in fiscal year 2003.

Dr. Reilly sought suggestions from the participants regarding their needs for data and information in setting priorities for health care quality improvement regarding the safety net and the broader health systems in States and communities.

Participant suggestions for data needs included:

• A performance-based system, measuring the effects of different programs such as linking Medicaid data.
• A change in how encounter data are collected. Medicaid claims data or health maintenance organization (HMO) encounter data lack laboratory reports.
• Data from department of corrections, drug, alcohol, and mental health systems.
• Data source suggestions: Healthy People 2010 and county health profiles.

Participant suggestions for coordination efforts included:

• State health offices.
• State Medicaid directors.
• Department of Health and Human Services/Health Resources and Services Administration field officers.
• Primary care organizations.
• National Association of State Mental Health Program Directors.
• National Association of State Drug Abuse Directors.
• Office of Women's Health.
• Center for Disease Control and Prevention (CDC) health alert network.
• Peer review organizations.

Participant suggestions for how AHRQ can make the report useful to State policymakers included:

• Look at how models work and build on programs that make a difference (e.g., prenatal care and the Women Infant Children's program (WIC) in preventing low-birthweight babies).
• Distinguish between data required to meet regulatory reporting rules versus other information that can help with improving health care quality.
• Choose some populations that are likely to be influenced first.
• Cover what some might view as ancillary services.
• Be patient-centered and culturally responsive.
• Be conscious of how the perceptions of the populations can affect quality measurements.

Reference

Arispe, I. Selected HHS data sources that could be used for the National Report on Health Care Quality. Presented at the Institute of Medicine Committee on the National Quality Report on Health Care Delivery. 2000, May.

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