Background
Casalino, L., R.R. Gillies, S.M. Shortell, et al. 2003. External Incentives, Information Technology, and Organized Processes to Improve Health Care Quality for Patients With Chronic Diseases. Journal of the American Medical Association 289:434–441.
The Institute of Medicine’s 1999 report on medical errors called for hospitals to use care management processes (CMPs) to improve quality of care for patients with chronic conditions. Based on a survey of over 1000 physician organizations, this study relates the use of CMPs to physician organizations’ respective IT capacity and incentive programs for improving quality of care.
Fernandopulle, R., T. Ferris, A. Epstein, et al. 2003. A Research Agenda for Bridging the 'Quality Chasm'. Health Affairs 22(2):178–190.
The authors lay out a research agenda needed to improve quality of health care in the United States in response to the knowledge gaps and areas identified in the IOM’s landmark report, Crossing the Quality Chasm.
Gauthier, A., and M. Serber, The Commonwealth Fund, A Need to Transform the U.S. Health Care System: Improving Access, Quality, and Efficiency, October 2005.
Reviewing studies and data on quality along several measures, this analysis compares quality of care in the U.S. to other countries and points out key differences in the respective health systems.
The Hastings Center. Health Care Quality Improvement: Ethical and Regulatory Issues, 2007.
This volume is a collection of original papers that provide in-depth discussion of how to manage quality improvement ethically and how to manage the interface with research ethics.
Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century.Committee on Quality of Health Care in America. Washington D.C.: National Academy Press, 2001.
Second report of the IOM Committee on the Quality of Health Care in America – (the first is the 1999 To Err is Human report) this report identifies strategies to achieve substantial improvements in the quality of health care delivered to Americans.
Kohn, L.T., J. Corrigan, and M.S. Donaldson, Eds. To Err is Human: Building a Safer Health System. Committee on the Quality of Health Care in America. Washington DC: National Academy Press, 2000.
This report from the Institute of Medicine focused the public spotlight on medical errors. It reported data from prior research and provided a national estimate of annual deaths due to medical errors.
Lohr, K. Medicare: A Strategy for Quality Assurance. Washington D.C.: National Academy Press, 1990.
This text provided an assessment of quality of care in the Medicare program early in the healthcare quality movement, which produced the standard definition of healthcare quality used today. It also defines poor quality care.
Millenson, M.L. Still Demanding Medical Excellence Policy Challenges in Modern Health Care, Chapter 11, May 2005.
This chapter provides an overview of the movement to improve healthcare quality, giving background to the challenges as well as the initiatives addressing quality concerns.
Miller, R., and H. Luft. 2002. HMO Plan Performance Update: An Analysis of the Literature, 1997–2001. Health Affairs, 21(4):63–86.
An overview of evidence on the performance of managed care in improving or diminishing quality. The authors conclude that quality varies widely among health plans, providers, and geographic areas.
Ottawa Conference, Organization for Economic Cooperation and Development, Paris, Measuring Up: Improving Health System Performance in OECD Countries, November 2001.
These proceedings from a 2001 Ottawa Conference provide an international exploration of the performance of health care systems, measuring performance against quality, efficiency and equity, and discussing the growing demands for accountability among funders and providers of health services.
Schneider, E., A. Zaslavsky, and A. Epstein. 2002. Racial Disparities in the Quality of Care for Enrollees in Medicare Managed Care. Journal of the American Medical Association 287(10):1288–1294.
This study documented that among Medicare beneficiaries enrolled in managed care health plans, blacks received poorer quality of care than whites.
Schoen, C., R. Osborn, P.T. Huynh, et al. November 2005. Taking the Pulse of Health Care Systems: Patients with Health Problems in Six Countries. Health Affairs Web Exclusive.
Based a Commonwealth Fund study of data from Australia, Canada, Germany, New Zealand, the United Kingdom, and the United States, this article compares and contrasts the respective countries’ treatment for chronic conditions and the frequency of medical errors.
Weech-Maldonado, R., D. Shea, and V. Mor. January 2006. Relationship Between Quality of Care and Costs in Nursing Homes. American Journal of Medical Quality 21(1):40–48.
Based on a sample of 749 nursing homes in 1996, this study compares health outcomes with cost. The findings suggest that there is a cost threshold associated with quality.
Patient Safety
Bleich, S., The Commonwealth Fund, Medical Errors: Five Years After the IOM Report, July 2005.
Five years after the landmark IOM report on medical errors, this issue brief reviews progress in the areas of data standards for patient safety information, use of information technology, and patient safety programs.
Brennan, T.A., A. Gawande, E. Thomas, et al. September 2005. Accidental Deaths, Saved Lives, and Improved Quality. New England Journal of Medicine 353:1405–1409.
In this article, authors discuss challenges with measuring quality of care while suggesting ways to improve how quality is measured.
Gauthier, A., and M. Serber. 2005. Closing the Loop: Follow-Up and Feedback in a Patient Safety Program. Joint Commission Journal on Quality and Patient Safety 21.
This research article discusses feedback components for medical errors and quality reporting systems.
Hughes, R.G., and C.M. Clancy. October–December 2005. Working Conditions that Support Patient Safety Agency for Healthcare Research and Quality. Journal of Nursing Care Quality 20(4):289–292.
Based on data by the Agency for Healthcare Research and Quality, this paper reviews staffing and cultural factors that affect patient safety.
Leape, L.L., and D. Berwick. 2005. Five Years After To Err is Human: What Have We Learned? Journal of the American Medical Association 293(19):2384–2390.
Based on recommendations by the Institute of Medicine’s 1999 report, this article discusses subsequent progress and barriers to improving quality of care. It also poses new suggestions for increasing healthcare quality and advocacy.
Longo, D.R., J.E. Hewett, B. Ge, et al. December 2005. The Long Road to Patient Safety: A Status Report on Patient Safety Systems. Journal of the American Medical Association 294(22):2858–2865.
Based on a survey of all acute care hospitals in Missouri and Utah in 2002 and 2004, this study estimates hospital progress toward the IOM quality of care goals. The authors suggest that hospital progress is modest and that much more effort is required to achieve the IOM goals.
Information Technology
Burke, D., N. Menachemi, and R.G. Brooks. January/February 2005. Diffusion of Information Technology Supporting the Institute of Medicine’s Quality Chasm Care Aims. Journal of Healthcare Quality.
Based on a survey of Florida hospitals, this study discusses the utilization rates of health information technology as it pertains to quality of care aims created by the 1999 Institute of Medicine report.
Chaudhry, B., J. Wang, S. Wu, et. al. May 2006. Systematic Review: Impact of Health Information Technology on Quality, Efficiency, and Costs of Medical Care. Annals of Internal Medicine 144(10):742-52.
This research review discusses the impact of health information technologies through key findings on quality, efficiency, and cost of clinical care.
Etheredge, L., D. Eddy, et al. January 26, 2007. Health IT and Rapid Learning. Health Affairs Web Exclusive 26(2).
This issue features a series of articles on the use of electronic health record databases and other health information technology. The articles cover a range of topics, including the need for health IT, possible challenges in implementation, and potential benefits of rapid learning systems.
Hillestad, R., J. Bigelow, A. Bower, et al. 2005. Can Electronic Medical Record Systems Transform Health Care? Potential Health Benefits, Savings, and Costs. Health Affairs 24(5):1103–1117.
Based on comparisons to savings and losses in other industries after the implementation of electronic records, this paper estimates financial impacts of electronic medical records with respect to medical safety and health management
Jha, A.K., J.B. Perlin, K.W. Kizer, et al. 2003. Effect of the Transformation of the Veterans Affairs Health Care System on the Quality of Care. New England Journal of Medicine 348:2218–2227.
Using performance data from VA hospitals, this study compares quality performance ratings from before and after the implementation of a performance improvement initiative.
Kilo, C.M. September/October 2005. Transforming Care: Medical Practice Design and Information Technology. Health Affairs 24(5):1296–1301.
This paper provides examples and best practices of ambulatory care providers who have implemented information technology innovations in their healthcare quality efforts. Based on these cases, the author discusses systematic changes associated with the use of information technology.
Koppel, R., J.P. Metlay, A. Cohen, et al. March 2005. Role of Computerized Physician Order Entry Systems in Facilitating Medication Errors. Journal of the American Medical Association 293(10):1197–1203.
Based on a two-year observational and interview study of hospital staff using a CPOE system, this paper discusses the healthcare quality hazards potentially prevented and also raised by CPOE systems.
Poon, E.G., A.K. Jha, M. Christino, et al. January 5, 2006. Assessing the level of healthcare information technology adoption in the United States: a snapshot. BMC Medical Informatics and Decision Making 6:1.
Based on interviews with healthcare quality stakeholders, this study explored opinions, utilization, and barriers to implementation of information technologies in American healthcare.
Pay-for-Performance
Dudley, R.A. October 2005. Pay-for-Performance Research: How to Learn What Clinicians and Policy Makers Need to Know. Journal of the American Medical Association 294(14):1821–1823.
This editorial synthesizes recent research on pay-for-performance initiatives and provides commentary on how this data can be utilized for practical improvements in quality of care.
Beckman, H., T. Mahoney and R. Greene, The Commonwealth Fund. Current Approaches to Improving the Value of Care: A Physician's Perspective, December 2007.
This report reviews strengths and weaknesses of the four most popular strategies to address cost and efficiency: pay-for-performance, public reporting, consumer-directed health plans, and tiered or limited network.
Bodenheimer, J., and H. May. December 2005. Can Money Buy Quality? Physician Response to Pay-for-Performance. Center for Studying Health System Change Issue Brief No. 102.
Based on physician surveys from a nationally-representative sample of hospitals, this study explores physician opinions about physician payment based on quality performance, discussing the barriers and challenges to implementing pay-for-performance programs.
Conrad, D.A., and J.B. Christianson. September 2004. Penetrating the “Black Box”: Financial Incentives for Enhancing the Quality of Physician Services. Medical Care Research and Review 61(3):Suppl, 37S–68S.
This study explores the impact of financial incentives for physicians on quality of care for patients.
Rosenthal, M.B., R.G. Frank, Z. Li, et al. October 2005. Early Experience with Pay-for-Performance, From Concept to Practice. Journal of the American Medical Association 294(14):1788– 1793.
Based on administrative reports of physician group quality from 2001 to 2004, this study examined improvements in quality of care before and after pay-for-performance initiatives began.
Hibbard, J.H., J. Stockard, and M. Tusler, Hospital Performance Reports: Impact on Quality, Market Share, and Reputation, 2005.
This study discusses the public performance reports and their relationship to reputation and long-term results.
Leatherman, S., and D. Berwick. 2003. The Business Case for Quality: Case Studies and An Analysis. Health Affairs 22(2):17–30.
This article discusses whether improving quality of care yields positive financial results. Using case studies from smoking cessation, diabetes, and cholesterol management programs, the authors argue that hospitals could achieve better quality of care if payment policies provided incentives to those who invest in healthcare quality improvements.
Schneider, E.C., A.M. Zaslavsky, and A.M. Epstein. December 2005. Quality of Care in For-Profit and Not-For-Profit Health Plans Enrolling Medicare Beneficiaries. American Journal of Medicine 118(12)1392–1400.
Observing Medicare HEDIS (Health Plan Employer Data Information Set) scores, this study compared the quality scores of for-profit and non-profit hospitals.
Stewart, D. Pacific Business Group on Health, Aligning Physician Incentives: Lessons and Perspectives from California, September 2005.
Based on a conference sponsored by several major health care organizations, this report explores physician measurement and pay-for-performance programs.
Wennberg, J., J.L. Freeman, and W.J. Culp. 1987. Are Hospital Services Rationed in New Haven or Over-Utilised in Boston?Lancet 1(8543):1185–1189.
This article describes small area variations in medical care, showing that Boston hospitals spent nearly twice as much as New Haven hospitals in 1982 using far more bed days, and with no better results.
Data Collection and Measurement
Agency for Healthcare Quality, National Healthcare Quality Report: Background on the Measures Development Process, May 2005.
The National Healthcare Quality Report measures quality on multiple indicators, tracking annual patterns in quality of care based on these indicators. This article provides an overview of how these indicators were selected.
Beal, A., J.P. Co, D. Dougherty, et al. January 2004. Quality Measures for Children’s Health Care. Pediatrics 113(1):199–209.
The authors review the literature to assess the existing health care quality measures for children and identify areas requiring additional research and development, such as measures assessing patient safety, living with illness, end-of-life care and age-specific measures.
Davidoff, F., and P. Batalden, Pacific Business Group on Health, Toward Stronger Evidence on Quality Improvement. Draft Publication Guidelines: The Beginning of a Consensus Project, September 2005.
This paper proposes guidelines to standardize the publication of healthcare quality reports.
Donabedian, A. Explorations in Quality Assessment and Monitoring, Volumes I-III. Ann Arbor, MI: Health Administration Press, 1980.
Donabedian’s three volumes supply the basic model for understanding health care processes and contribute to the foundation of modern thinking on quality in health care.
Donabedian, A. September 1988. The Quality of Care: How Can It Be Assessed?Journal of the American Medical Association 260(12).
This article provides a summary of Donabedian’s key quality insights.
Drain, M., and P.A. Clark. July/August 2004. Measuring Experience from Patient’s Perspective: Implications for National Initiatives. Journal of Healthcare Quality Online W4-6–W4-16.
This article discusses the strengths and weaknesses of patient reporting and rating mechanisms for measuring healthcare quality. It provides suggestions for measuring patient experiences in quality initiatives.
Jacobs, R., M. Goddard, and P. Smith. December 2005. How Robust Are Hospital Ranks Based on Composite Performance Measures?Medical Care 43(12):1177–1184.
Analyzing data from 117 hospitals, this study discusses the validity of performance measures in gauging healthcare quality.
Provonost, P.J et al. November 2007. A Framework for Health Care Organizations to Develop and Evaluate a Safety Scorecard. JAMA 298(17):2063-65.
This commentary proposes a framework to help health care organizations more effectively and efficiently develop their safety scorecards, evaluate their validity, and understand measures that are appropriate to present as rates.
Werner, R.M., and D.A. Asch. March 2005. The Unintended Consequences of Publicly Reporting Quality Information. Journal of the American Medical Association 293(10):1239–1244.
This article discusses the main quality goals and limitations regarding the public reporting of quality information.
Improvement Initiatives
Audet, A.J., M.M. Doty, J. Shamasdin, et al. 2005. Measure, Learn and Improve: Physicians’ Involvement in Quality Improvement. Health Affairs 24(3):843–853.
Based on a 2003 Commonwealth Fund survey of physicians, this study explores the characteristics and factors influencing physician participation in quality of care initiatives. Full text of the original Commonwealth Fund report is available under Key Data: Public Opinion.
Berwick, D.M. 1989. Continuous Improvement as an Ideal in Health Care. New England Journal of Medicine 320(1):53–56.
Seminal article proposing replacement of quality assurance with quality improvement, borrowing from quality improvement methodologies used in U.S. and Japanese manufacturing.
Berwick, D.M., D.R. Calkins, J. McCannon, et al. January 2006. The 100,000 Lives Campaign: Setting a Goal and a Deadline for Improving Healthcare Quality. Journal of the American Medical Association 295(3):324–327.
In 2004, the Institute for Healthcare Improvement began the 100 000 Lives Campaign, a goal to save 100 000 lives by June 2006 due to improving healthcare quality. This paper reevaluates the challenges and interventions for improving quality six months before the campaign deadline.
Blumenthal, D., and C. Kilo. 1998. A Report Card on Continuous Quality Improvement. Milbank Quarterly 76(4).
In the early and mid-1990s, continuous quality improvement (CQI) was considered the essential strategy to improve health care quality. This article reviews and assesses the performance of CQI to date.
The Commonwealth Fund Commission on a High Performance Health System. December 2007. Bending the Curve: Options for Achieving Savings and Improving Value in U.S. Health Spending.
This report examines 15 federal policy options that have the potential to improve health care decision-making, align financial incentives with quality and efficiency and promote health and enhance disease prevention.
Davies, E., and P.D. Cleary. 2005. Hearing the Patient’s Voice? Factors Affecting the Use of Patient Survey Data in Quality Improvement. Quality and Safety in Health Care 14:428–432.
Based on interviews with health professionals, this study discusses professionals’ experience with patient surveys, and factors influencing the effectiveness of survey results.
Shojania, K.G., and J.M. Grimshaw. January 2005. Evidence-Based Quality Improvement: State of the Science. Health Affairs 24(1):138–150.
This paper reviews the approaches to researching healthcare quality indicators (QI) and to putting research into practice, discussing strengths and weaknesses of the approaches.
Snyder, C., and G. Anderson. June 2005. Do Quality Improvement Organizations Improve the Quality of Hospital Care for Medicare Beneficiaries? Journal of the American Medical Association 293(23):2900–2907.
Under the charge of the Centers for Medicare & Medicaid Services, Quality Improvement Organizations (QIOs) monitor the quality of care provided to Medicare beneficiaries. Based on data from 4 QIOs among 5 states, this study compares hospital participation with QIOs to their respective hospital quality ratings.
Stuyck, J., The Commonwealth Fund. Patient-Centered Care: What Does It Take?. October 2007.
Based on interviews with leaders of patient-centered organizations and initiatives, this report identifies seven key factors for achieving patient-centered care at the organizational level and how these factors can be successfully implemented through case examples.