Clinton proposes standard performance measures>

Is a national benchmarking system in the works?

In March, President Clinton approved the final report of a $1.8 million study by the Advisory Commission on Consumer Protection and Quality in the Health Care Industry. The report made more than 50 recommendations for developing national quality improvement and performance measurement standards. (For a complete list of recommendations, see chapters 3-5 of the report on line at this World Wide Web address:

"The goal is to empower consumers and businesses to make informed purchasing decisions based on quality performance records," says Richard Sorian, the commission's deputy director.

The advisory commission's major recommendations are as follows:

1. Establish national improvement goals.

The report calls for a public/private partner -ship to identify a concise set of core aims for improve ments accompanied by specific, meas urable objectives. Those aims and objectives should be concentrated around conditions with the most potential for improvement, such as those that:

· have the greatest impact on reducing morbidity and mortality;

· improve functional capacity and quality of life;

· have wide variability in practice;

· are common and/or costly.

2. Bring order to the industry's current measurement system.

Based on these aims and measurements, each sector of the industry - health plans, hospitals, nursing homes, and individual physician practices - should have its own core set of quality indicators. Outcomes should be reported through a standardized system and made available to the public.

3. Establish benchmarking and monitoring system.

Once aims for improvement are identified, an ongoing monitoring system must track pro gress in achieving the goals established. "This requires identifying key standard measures to assess quality of care in targeted areas and collecting data on these measures," Sorian says.

In some areas, existing data systems may be available for tracking quality of care, whereas in many other areas, data collection and reporting systems will need to be developed. "The resulting data on these measures will allow monitoring to track improvements and will provide benchmarks for health organizations to assess their performance relative to national standards," he says.

Bringing quality groups together

The report recommended establishing a collaborative effort of key organizations currently involved in quality measurement as well as existing data sources, including the following:

· public measurement systems such as federal health surveys and Medicare and Medicaid databases;

· private quality measurement systems such as the National Committee for Quality Assurance's measurement database (Quality Compass), the Joint Commission on Accreditation of Healthcare Organizations' proposed database (ORYX), and the American Medical Association's physician credentialing database;

· community-level public health data collected by the Centers for Disease Control and Prevention;

· state-level data such as the Maryland Health Care Assessment and Cost Commission, the Minnesota Health Data Institute, the Alabama Health Care Council, and the Cleveland Health Quality Choice project.

A public, private partnership

The challenge will be getting those public and private entities to provide publicly available data, Sorian says. "It will be essential not only in reaching a national consensus on priority aims for improvement but also for effectively measuring quality indicators and tracking improvements."

Next, the commission recommends creating two complementary entities - a public one to set aims and objectives for quality improvement and a private one to identify measures to fulfill those aims.

4. Form the Advisory Council for Health Care Quality.

This group would track the nation's progress in meeting those aims and objectives and establish goals and objectives for quality measurement and reporting by health care organizations and providers. It also would track industry compliance with the Consumer Bill of Rights and Responsibilities, another element of the report that outlines what patients should expect from their providers. (For more information on the bill of rights and responsibilities, see story, p. 71.)

Members would include representatives from the public and private sectors with expertise in health care quality, patient and consumer needs, the purchasing and delivery of health care services, the management of health plans, research, public health, and the education and training of health care practitioners.

5. Create the Forum for Health Care Quality Measurement and Reporting.

This group would "establish a core set of quality measures that would provide the public with clear indications of the quality of care available to them," Sorian says.

For example, it would be responsible for devising a mechanism through which performance results would be delivered to the public.

"It will coordinate strategies for assuring the widespread public availability of valid and reliable information to the public," Sorian explains.

Members would include public and private purchasers of health care services, consumers, health plans, health care practitioners, and others, thus assuring the systemwide capacity to evaluate and report on the quality of care.

6. Establish an annual award for excellence in health care quality, based on the Malcolm Baldrige National Quality Award.

"This would increase public awareness of health care excellence, motivate organizations to improve quality, encourage dissemination of best practices, and recognize achievement in areas established as national aims for improvement," he says.

[Editor's note: Copies of the commission's report can be downloaded from its World Wide Web site: Printed copies are available by calling (800) 732-8200 or writing to Consumer Bill of Rights, P.O. Box 2429, Columbia, MD 21045-1429.]