Institute:Office of National Coordinator (ONC) Workforce Training Curriculum
Component:The Culture of Health Care
Unit:Quality Measurement and Improvement
Lecture:Definitions and framework for assessing quality
What is known about health care quality
Slide content:Definitions and Operationalization What is health care quality? Different views Donabedian , 1988: That kind of care which is expected to maximize an inclusive measure of patient welfare, after one has taken account of the balance of expected gains and losses that attend the process of care in all its parts (in Blumenthal, 1996) Lohr , IOM, 1990: The degree to which health services for individuals and populations increase the likelihood of desired outcomes and are consistent with current professional knowledge (in Blumenthal, 1996) In an era of rising costs and concerns about quality, physicians and the health care system must have public accountability ( Chassin et al., 2010, Chassin & Loeb, 2011) Value based reimbursement models 4
Slide notes:This lecture discusses the definition and framework for assessing health care quality. Its important to define terms and look at how to operationalize them. What exactly is health care quality? Although there are a number of definitions, one of the thought leaders in health care quality, Avedis Donabedian [dawn-uh- behd - ee -yen], stated in a1988 article on health care quality that its that kind of care thats expected to maximize an inclusive measure of patient welfare, after one has taken account the balance of expected gains and losses that attend the process of care in all its parts. Another definition was put forth by Lohr , who was the lead author on an Institute of Medicine report published in 1990. He defined quality as the degree to which health services for individuals and populations increase the likelihood of desired outcomes and are consistent with current professional knowledge. These definitions and others were reviewed by Blumenthal [ bloom - ehn - thall ] in 1996. The current century is an era of rising costsand rising concerns about the quality of care that is delivered. Theres a growing recognition that physicians must have some amount of public accountability. This impression is highlighted with the movement toward value-based payment models in which reimbursement is based on positive patient outcomes. ORC International conducted a study, The 2014 State of Value-Based Reimbursement, which involved four hundred sixty-four payers and hospitals. The study identified that in this changing payment landscape, more than two-thirds of payments are expected to be based on value measurement in five years. The 2016 HIMSS Cost Accounting Survey examines the approach health care providers are pursuing as they manage this changing landscape. The findings revealed the following: Forty-five percent of providers represented are participating in some form of alternative payment model Three percent believe their organization is highly prepared to make the transition from fee-for-service to a value-based payment system The top three needs participants identified for the successful transition to a value-based payment system are [quote] Tools to track and evaluate quality of care , Better communication between disparate providers , and Consistent definition of quality by specific type of disease . [end quote] Yet its not clear that anyone knows all of the right things to do when it comes to improving quality. Many resources investigate practices focused on care coordination across the patient care continuum and demonstrate positive patient outcomes. One resource is the National Quality Forum consensus report Preferred Practices and Performance Measures for Measuring and Reporting Care Coordination. 4