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Putting Measurement to Work: Improving the Quality of Health Care Delivered to Adults

Existing Frameworks


Ann Page, Technical Director, Quality System Management, Centers for Medicare and Medicaid Services (CMS).

Dr. Thomas W. Reilly, Director, National Healthcare Quality Report, Agency for Healthcare Research and Quality (AHRQ).

A framework is a tool to organize the way you think about health care quality. According to Ms. Ann Page and other workshop speakers, the framework chosen defines the areas of quality to be measured (e.g., access, effectiveness, safety, use) and specific attributes to be measured (e.g., waiting times, immunization rates) to ascertain performance in each of those areas.

Many frameworks have been developed from different perspectives and with different intended uses. For example, providers may focus on the clinical aspects of care whereas consumers may want to assess the level of respect and understanding in the patient/provider encounter. States have many frameworks they can choose from or adapt:

  • Medicaid Managed Care Proposed Rules.
  • Medicare clinical priorities.
  • Private accreditation.
  • State licensing.

AHRQ is developing comprehensive framework with input from the Institute of Medicine. Dr. Reilly, Director of AHRQ's National Healthcare Quality Report anticipates that this framework will form the basis of an annual report on the nation's progress in improving health care quality. This report was mandated by Congress in the Healthcare Research and Quality Act (PL. 106/129). The framework will measure quality by including:

  • Components of health care quality including safety, effectiveness, patient centeredness, and timeliness.
  • The consumer perspective on health care needs, reflecting the life cycle of people's involvement with the health care system or their reasons for seeking care. This perspective builds on the work of the Foundation for Accountability (FACCT) and includes staying healthy, getting better, living with illness or disability, and coping with the end of life.

The framework and resultant report will inform national and State policymakers, consumers, purchasers, and providers on condition-specific care.

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