ABSTRACT: Is It Time to Change Directions of Quality Measures?
Current sets of measures of clinical quality were not designed to adequately describe trends in the overall health of individuals and of populations. There is no definition of “health” in the 2013 National Quality Strategy (NQS) provided in the Annual Report to Congress by the Secretary of Health and Human Services (HHS).1 A purpose of the report “is to build a national consensus on how to measure quality.” The focus of the NQS is largely on measures of health care rather than on measures of health. On the other hand, the Centers for Medicare and Medicaid Services has set national goals with its Triple Aim of better health for the population, better health care for individuals, and lower cost of care.2 Although existing measures are intended to describe health care, they do not provide metrics for the population. Measures of “systemness” and well-being of both individuals and populations should be developed to better serve all 3 elements.
Existing measures of quality used in the NQS report have been based largely on the quality model described by Avedis Donabedian, MD, MPH. This framework, based on measures of structure, process, and outcomes, has been adopted for the development of quality measures by organizations such as the National Committee for Quality Assurance, the American Medical Association Physician Consortium for Performance Improvement, and the Agency for Healthcare Quality and Research (AHRQ), among others. Measures developed by these and other organizations may be reviewed by the National Quality Forum (NQF) for endorsement.