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Pursuit Of Quality |
PROLOGUE
The Pursuit Of Quality
PROLOGUE: The nation’s first National Healthcare Quality Report, released in the final days of 2003 by the Agency for Healthcare Research and Quality, reports measurable improvements in several indicators of quality. Major goals of the health care quality initiative—reducing medical errors, using evidence-based practices, improving systems for reporting errors, encouraging the use of electronic health information, and improving patient protections—are well known to those advocating improved health care quality. The report states that quality improvements have "come about not through mandates, but rather through innovation that is led by ‘champions’ with the vision to customize improvements to local circumstances." The report highlights progress in some areas in which quality measures are well defined and widely accepted, such as improvements in cancer screening, vaccination, and immunization rates. Unfortunately, for many other conditions, progress has not been made, measures are not commonly agreed upon, or data are not collected. (Of fifty-seven measures tracked in the report, improvement was reported in twenty, while the remaining indicators either showed no improvement or deteriorated.) While all is not doom and gloom, and "the vast majority of patients are getting the care they need in many areas," the report reveals that there is plenty of room for improvement in the quality of our nation’s health care.
The papers that follow delve into some of the challenges that confront those who would deliver high-quality care, from hospitals, to solo and small-group physician practices, to larger health systems. Regular readers of Health Affairs will recognize many of the authors as key players in health care quality research. In the first paper Kelly Devers, Hoangmai Pham, and Gigi Liu focus on hospitals’ efforts to improve patient safety. Contrary to the National Healthcare Quality Report, they find that hospital "champions" are motivated to improve patient safety more by the accrediting demands of a major quasi-regulatory body, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), than by market forces, perhaps reflecting the power of the business incentive. (Medicare, the source of approximately 40 percent of hospital revenues, requires such accreditation.)
Robert Miller and Ida Sim polled small group practices to identify how they are faring in efforts to implement electronic medical records (EMRs), long viewed as a key element of achieving improved quality of care. High costs in terms of equipment, training, and time continue to pose serious hurdles to greater implementation of this technology. Meanwhile, Meredith Rosenthal and colleagues look at ways to make quality worthwhile in their paper exploring "pay-for-performance" incentives. Addressing the reality that improvements in quality often reduce providers’ revenues, they inventory and examine interventions that reward providers showing improved quality. The variety of approaches and their financial impacts reflect remarkable ingenuity and innovation.
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