Traditionally, health care quality measures have focused primarily on specific clinical processes employed by a given doctor or hospital — for instance, whether patients receive beta blockers after heart attacks. But in an era when the definition of what good health care constitutes is changing swiftly, and the IT systems used to capture clinical quality data grow ever nimbler and more sophisticated, the tools used to measure quality need to evolve as well.


During a joint conference call Wednesday with Premier Inc. and the National Quality Forum, Thomas Valuck, M.D., senior vice president of strategic partnerships for the National Quality Forum, drove that point home, describing the emergence and development of quality measures that will be used to assess everything from national mortality prevention to out-of-pocket costs for a given patient.

Taking their cues from the National Quality Strategy, which HHS released in March, the measurement community is beginning to define and craft a broader set of performance indicators, Valuck said. The National Quality Strategy focuses broadly on health and well-being, prevention of mortality, patient and family-centered care, patient safety, care communication and affordable care. In response, measurement developers are working on new tools that both analyze the care delivered across systems — like care coordination — while focusing on conditions, like depression, that haven't received a lot of attention from the measurement field in the past despite close links to other chronic conditions.

"We're moving into areas like population health, how to measure patient centeredness, patient safety and care coordination," Valuck said. "We're going to see measures evolving to address all of these areas of need."

Some of this work is happening already, said Richard Bankowitz, M.D. Premier's chief medical officer. When Medicare's value-based purchasing program launches in 2013, 70 percent of the scores will be based on clinical processes, while 30 percent will be dedicated to patient satisfaction. By 2014, Medicare's value-based purchasing program will base 25 percent of its scores on outcome measures, reducing the process measures to 45 percent of the total.

Ultimately, Valuck envisions health care quality measures functioning as a fluid, cascading system that can look at the impact of a specific condition or episode all the way from a patient's interaction with a doctor to the national population health picture. For instance, that would allow observers to follow progress on patients' control of cholesterol levels from data on a specific doctor's patients all the way to national population health statistics on cholesterol control.

"We've got to figure how to pull all this into core sets that … fit into this vision of harmonized performance measurement," Valuck said.

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Haydn Bush is senior online editor for Hospitals and Health Networks magazine. Follow his tweets at