Six Challenges In Measuring The Quality Of Health Care

PROLOGUE: As the configuration of the U.S. health care system continues to shift, it is increasingly important to assess the impact of the various changes, not just on national health spending, but on public health and quality of care as well. However, measuring quality is no simple task. As Elizabeth McGlynn, a RAND health policy analyst and an expert on quality issues, points out, patients, providers, and payers each define quality differently, which translates into different expectations of the health care system and thus differing evaluations of its quality. Having spent the past ten years focused on the development and application of quality measures for physical and mental health care, particularly in managed care settings, McGlynn provides an informed, objective overview of the current state of quality measurement and the challenges that must be addressed to move forward. McGlynn's work has included evaluations of the quality of prenatal care in managed care organizations, comparisons of the appropriateness of angiography and coronary artery bypass graft surgery between the United States and Canada, and assessments of the quality of care provided to persons with schizophrenia or depression. With funding from The Commonwealth Fund, McGlynn recently provided technical assistance to the National Committee for Quality Assurance's (NCQA's) Committee on Performance Measurement during the development of HEDIS 3.0. McGlynn now serves as liaison between the research community and the committee. McGlynn holds a doctorate in public policy analysis from the RAND Graduate School in Santa Monica, California. ABSTRACT: Quality monitoring is becoming an accepted method for purchasers, patients, and providers to evaluate the value of health care expenditures. Important advances in the science of quality measurement have occurred over the past decade, but many challenges remain to be addressed so that quality monitoring may realize its potential as a counterforce to the demands of cost containment. This paper describes six such challenges (balancing perspectives, defining accountability, establishing criteria, identifying reporting requirements, minimizing conflict between financial and quality goals, and developing information systems) and proposes some ways in which the public and private sectors might collaborate to respond effectively.