Measuring and Improving Quality of Care

First Scientific Forum on Assessment of Healthcare Quality in Cardiovascular Disease and StrokeQuality of Care and Outcomes Research in CVD and Stroke Working Groups* Q uantifying and improving the quality of health care is an increasingly important goal in American medicine.To address this need, the First Scientific Forum on Assessment of Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke was held May 24 to May 26, 1999.This conference brought together providers, researchers, payers (eg, the Health Care Financing Administration [HCFA] and the US Department of Veterans Affairs [VA]), managed care, industry, and assessors of healthcare quality (eg, the Joint Commission on Accreditation of Healthcare Organizations[JCAHO], National Committee for Quality Assurance [NCQA], and Foundation in Accountability[ FACCT]) to discuss the current state of quality assessment in cardiovascular disease and stroke.An important aspect of the forum was the 4 working groups that were formed to focus on acute myocardial infarction (AMI), heart failure, stroke, and methods of quality assessment and improvement.Members of the working groups are listed in the Appendix.The discussion and lectures that took place at the conference illuminated several important methodological challenges inherent in judging the quality of health care and evaluating changes in it over time.This summary highlights several of the most important topics in quality measurement.It also includes summary reports on quality measurement provided by conference working groups on AMI, heart failure, and stroke. Topics in Quality Measurement Involvement of Healthcare ProvidersThe importance of measuring and monitoring healthcare quality is no longer in doubt.Yet quantifying healthcare quality is a complex and challenging process for which public and payer demands clearly exceed current capabilities.The conference presenters and participants articulated the view that healthcare professionals need to engage in efforts to evaluate quality of care to ensure its relevance and validity.From selecting patient cohorts to guiding analyses and interpretation, the entire process of quality assessment requires judgment and choices that should be influenced by the clinical realities of medical care, a perspective that clinicians uniquely possess.Accordingly, it is considered essential that healthcare providers acquire the knowledge to participate actively in the assessment of healthcare quality.*For a complete list of authors, please see the Appendix."Measuring and Improving Quality of Care: A Report From the American Heart Association/American College of Cardiology First Scientific Forum on Assessment of Healthcare Quality in Cardiovascular Disease and Stroke" is an American Heart Association/American College of Cardiology Conference Proceedings statement.The recommendations set forth in this report are those of the conference authors and do not necessarily reflect the official position of the American Heart Association, the American College of Cardiology, or other organizations represented at the conference.This article is being published simultaneously in the April 2000 issue of Stroke.A companion article, "Evaluating Quality of Care for Patients With Heart Failure," appears in the March 28, 2000, online edition of Circulation.