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Introduction to Quality Measurements
David B. Nash, MD, MBA, is The Dr. Raymond C. and Doris N. Grandon Professor of Health Policy and is Chairman of the Department of Health Policy at Jefferson Medical College. Here, he defines quality measurement and discusses its evolution and its future. Dr. Nash traces the evolution of quality measurement from being viewed with skepticism to sometimes grudging acceptance. He refers to such works as Quality of Healthcare in the United States: A Chart Book and Reducing the Cost of Poor Quality Healthcare Through Responsible Purchasing Leadership, the latter stating that poor quality care costs the nation nearly $600 billion annually. The author provides definitions of quality from the Institute of Medicine, and its books To Err is Human and Crossing the Quality Chasm, the latter issuing ten commandments and six directives for quality care. The Agency for Healthcare Research and Quality produced a similar work titled Making Healthcare Safer: A Critical Analysis of Patient Safety Practices, which listed 11 opportunities for wider implementing of safety practices. Recent developments in quality measurement, says Dr. Nash, call for standardization, benchmarking, and continuous measurement and improvement of quality, with rewarding physicians for certain outcomes or penalizing them for poor performance also an option. So far as the future is concerned, the National Patient Safety Center calls for accreditation of healthcare institutions based upon outcomes for specific diseases. And the Leapfrog Group for patient safety calls for widespread implementation of electronic medical records, intensivist-trained physicians for ICUs, and referrals based on evidence with regard to outcomes. The lecture concludes with the notion that decades of research show that quality care costs less. |
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