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AHRQ announces a major step in improving quality of care

In a major step toward improving the quality of the U.S. health care system, a broad-based coalition of health care agencies and organizations—the Ambulatory Care Quality Alliance (AQA)—has selected a "starter set" of 26 clinical performance measures for the ambulatory care setting. The starter set of measures is intended to provide clinicians, consumers, and purchasers with a set of quality indicators that may be used for quality improvement, public reporting, and pay-for-performance programs.

The AQA, initially convened by the American Academy of Family Physicians, the American College of Physicians, America's Health Insurance Plans, and the Agency for Healthcare Research and Quality, consists of a large body of stakeholders that represent clinicians, consumers, purchasers, health plans and others. The mission of the AQA is "to improve health care quality and patient safety through a collaborative process in which key stakeholders agree on a strategy for measuring, reporting, and improving performance at the physician level." A secondary aim of the AQA is to promote uniformity in order to provide consumers and purchasers with consistent information and to reduce the burden on providers.

The uniform starter set comprises prevention measures for cancer screening and vaccinations; measures for chronic conditions including coronary artery disease, heart failure, diabetes, asthma, depression, and prenatal care; and, two efficiency measures that address overuse and misuse. Except for the two efficiency metrics, the AQA limited its review to those measures that are currently under review by the National Quality Forum. The starter set represents an initial set of measures that physicians may use to collect the data and report their performance.

The measures in the starter set will lead to a uniform set of measures for ambulatory care that can focus quality efforts and give consumers the data they need to make more informed health care decisions. The starter set of measures may be incorporated into performance-based payments as early as next year. This approach is similar to the Hospital Quality Alliance that has involved a broad array of stakeholders with the goal of producing a standardized set of measures for inpatient care.

The AQA intends to invite additional provider, purchaser and consumer groups to join steering its committee. The AQA calls on employers and health plans to endorse this effort and to use the starter set to improve quality of care in the ambulatory setting.

The starter set of measures and background information are available online. Go to for background information and to access the measures.

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