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Defining Quality Care

Objective of Section

To define quality in diabetes care and provide information on current diabetes-specific programs to improve care, which are often coupled with financial incentives.

Key Concepts

  1. The focus on health care quality was brought into focus by the Institute of Medicine (IOM) report “To Err Is Human”1 in 1999 and further defined by the IOM report “Crossing the Quality Chasm”2 in 2001.
  2. Current national programs that aim to improve quality in diabetes treatment increasingly focus on outcomes-based measurements that are patient-centered. This focus is informed by the Affordable Care Act and is often linked to financial incentives.
  3. Quality measures continue to evolve, requiring ongoing monitoring.

Introduction

The quality of health care in the United States was the focus of the Institute of Medicine (IOM) report “To Err Is Human.” The report focused on medical errors occurring in U.S. hospitals, causing as many as 100,000 deaths per year, and a failing health care delivery system that was poorly organized around quality, leading to poor results. In 2001, the IOM published “Crossing the Quality Chasm,” a document that attempts to define quality of care and provides a structure to improve the performance of the health care system. The efforts to improve quality in the U.S. health care system have resulted in marginal results. The most recent report on hospital-based deaths due to medical errors places the number at 440,000 per year, the third leading cause of death in the United States.2

The focus on diabetes metrics as it relates to quality pre-dates the IOM reports. The National Committee for Quality Assurance and the Healthcare Effectiveness Data and Information Set (HEDIS)3 was developed when “managed care” was introduced during the Clinton administration. HEDIS was the first national program that captured diabetes-related metrics. In 1997, the first diabetes-specific measures were developed as part of the Diabetes Quality Improvement Project.4 Since 2000, a number of national organizations, private insurers, government organizations, and academicians have advanced system changes and developed guidelines and metrics to improve diabetes care.

This section covers the structure and types of measures currently used in diabetes care. In addition, there is a brief discussion of current programs, including the Medicare Physician Quality Reporting System (PQRS),5 HEDIS measures for diabetes,6 Patient Centered Medical Home,7 ambulatory care sensitive admissions, and hospital-acquired conditions (HAC).8

The current status of the literature of diabetes care and the evolving field of measuring quality are presented. There are now thousands of metrics that are linked to measures of quality or value. Quality is increasingly being measured by outcomes, whether it is a 30-day readmission rate or an estimate of a person’s 10-year mortality risk. With advanced technology, the quality and quantity of data are improving to allow better ways to measure quality. Some of these changes are currently being incorporated into quality measures.

References

1. Institute of Medicine (IOM). To Err Is Human: Building a Safer Health System. Washington, DC: The National Academy Press; 1999.
2. IOM. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: The National Academy Press; 2001. Available at https://iom.nationalacademies.org/~/media/Files/Report%20Files/2001/Crossing-the-Quality-Chasm/Quality%20Chasm%202001%20%20report%20brief.pdf (PDF, 97.1 KB).
3. National Committee for Quality Assurance (NCQA). HEDIS® & performance measurement. Available at http://www.ncqa.org/HEDISQualityMeasurement.aspx.
4. Fleming BB, Greenfield S, Engelgau MM, Pogach LM, Clauser SB, Parrott MA. The Diabetes Quality Improvement Project: Moving science into health policy to gain an edge on the diabetes epidemic. Diabetes Care. 2001;24(10):1815-20.
5. Centers for Medicaid and Medicare Services. Physician Quality Reporting System. Available at https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/index.html.
6. NCQA. HEDIS Overview. Available at http://www.ncqa.org/Portals/0/HomePage/Compiled_PC_Materials.pdf (PDF, 2.23 MB).
7. NCQA. NCQA PCMH 2014 standards, elements and factors. Available at http://www.ncqa.org/Programs/Recognition/Practices/PatientCenteredMedicalHomePCMH/DuringEarnItPCMH/PCMH2014ISSDataSources.aspx.
8. Centers for Medicare & Medicaid Services. Hospital-acquired conditions (present on admission indicator). Available at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalAcqCond.

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