1. Schroeder, Patricia RN, MSN, MBA, FAAN, Journal Editor

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We've Made Progress, But there's a Long Way to Go

Are you a "glass is half full," or "glass is half empty" person? Your perspective may determine the way you see the current state of quality measurement.


For those of you who are "half-fullers [horizontal ellipsis]"

Never before has there been such consistent outcries for sharing more information about quality of care with external constituencies. The public, employer groups, payers, legislators, you name it, others are asking for health care organizations to share more information about their state of health care quality to understand the value of health care received or to make more astute selections in health care providers. Across the country, more and more data are being shared or requested. One example has been the disclosure of quality of care data from long-term care by the Centers for Medicare and Medicaid Services, CMS. Reportedly on its heels will come quality reports reflecting home care, hospitals, and physician Medicare providers. The National Quality Report is being prepared, and while not anticipated to identify health care providers by name, will continue the pursuit of using quality data to better inform the public. The American Hospital Association has proposed voluntary quality reporting, and is a catalyst for similar projects within state hospital associations.


The Leapfrog Group is encouraging hospitals across the country to meet its quality expectations as well as voluntarily report their progress, and employer groups have joined the voices requesting more information on these elements of practice. And reported quality of care web sites are growing at a brisk clip [horizontal ellipsis] all of which use different criteria or measures of quality, some identifying specific organizations, and some reporting on regions or parts of the country. In addition, local and regional quality of care reporting initiatives can be found in virtually every part of the United States. Indeed, there has never been a time when we have had more discussion about quality of care, more available data on quality of care, and more data requests to health care organizations to "show their quality stuff." For those of us long termers in the quality field, it is the time we actually have awaited [horizontal ellipsis] when information about quality of care gets as much discussion as information about the cost of care.


But now for those "half-emptiers [horizontal ellipsis]"

The state of quality measurement in health care is frustratingly rudimentary. What are the measures of health care quality that will define the goodness of our care, service, and outcomes, and are sound in discriminating a great organization from a good one? Unfortunately, that is an ill defined question. Across the United States, and despite a growing body of science and evidence, there remain too few well tested quality measures. There are even fewer that are sufficiently well defined to allow different organizations to measure and make public their data in a way that scientifically justifies comparison to others and that accurately reflects differences. As a science, we have a long way to go in producing a quality report that is clear, descript, scientific, consistent, and reflects what the public needs to know.


And it is toward that goal we must keep working. It falls to us to continue the pursuit of the most useful, well-defined measures of quality, so as to help demonstrate quality of care, our professional accountability. Just because the reports are going public does not mean that we have arrived at the promised land of measures. As we help educate our public in what current measures and reports say, as well as what they do NOT say, we must continue to refine the science, and enthusiastically pursue the next generation of how this needs to look.


We actually haven't moved too fast in this regard over the past 20 years, but current state momentum may have us pushing the envelope quickly to establish a more effective data set.