Quality measures should be locally relevant, IOM says

Photo used with permission from Shutterstock.comPhoto used with permission from Shutterstock.com

To really understand population health in coming decades, the United States needs properly aligned quality measures in healthcare, according to a report by the Institute of Medicine (IOM).

Tasked with reviewing national public health quality efforts and the Healthy People 2020 strategy, the IOM came to a conclusion shared by others: “partners in the multisectoral health system currently use a vast and complex array of measures of quality in a manner that seems uncoordinated.”

National Health IT Coordinator Farzad Mostashari, MD, and other federal health officials recently called for a review of current quality measures with an eye toward a new framework — and the CEO of the National Quality Forum recently said the national quality measurement system is largely a reflection that the U.S. healthcare system “is still more provider-centered than patient-centered.”

Not that the IOM has any easy solutions.

A nonprofit charter of the National Academy of Sciences, the IOM is suggesting that the Department of Health & Human Services (HHS) and national healthcare stakeholders “promote the use of a unified portfolio of measures” — envisioning that it “would emerge from the endorsement process across the country and in a range of settings including the clinic and the community.”

[Q&A: Why the U.S. actually needs those crazy ICD-10 codes]

Diverse as the interests in population health quality would be across the country, the IOM’s recommended portfolio would have a summary of health scores “reflecting population-level healthy outcomes and healthy conditions; a balance of “parsimony with sufficient breadth”; and a way to allow for “assessment, improvement and accountability of the multisectoral health system.”

For specific measurements, the IOM echoed other recent suggestions in focusing less on healthcare processes as indicators of quality and more on conditions and outcomes.

As for what conditions and outcomes to measure, the IOM is suggesting that HHS focus on those “reflective of a highly preventable burden” and those “actionable at the appropriate level for intervention.”

Related criteria for measurements, the IOM noted, are timeliness, usability and understandability.

“HHS should ensure the implementation of a systematic approach to develop and manage a portfolio of
measures of quality…and also should establish or designate a nongovernmental and appropriately equipped entity to endorse measures of quality,” the IOM suggested.

New quality measures will also need “local relevance,” the IOM said — so local health and government organizations can focus on the health of local populations.

For instance with tobacco use statistics and cessation and prevention campaigns, state and local health departments will need “data and information technology capabilities to understand the extent and nature of tobacco use in their communities.”

Health departments also need those tools because of the complexity of the causes of health conditions — like infant mortality. “A range of social, physical, environmental and economic conditions, and changes in behavioral risk factors relate to infant mortality and preterm birth. However, there are considerable gaps in the evidence base,” the IOM said.

[See also: New eSupplement: ICD-10: Compliance & Beyond]

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