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The American healthcare system offers millions of patients access to healthcare provided by highly skilled, committed professionals and first-rate healthcare institutions, as well as the advantages of the latest innovations in clinical research, technology, and treatment. At the same time, the system is marked by serious and pervasive deficiencies in quality. Quality problems affect all patients, regardless of age, gender, financial resources, or race or ethnicity. In addition, quality problems cut across the delivery system, and are not the result of any single financing or payment arrangement. Quality deficiencies result in increased mortality and morbidity and in failure to alleviate conditions that cause pain and disability, leading to a lower quality of life, a less productive workforce, and billions of dollars in unnecessary costs.
There are large gaps between the care people should receive and the care they actually do receive. Only about 50% of patients receive recommended preventive care, 70% receive recommended acute care, and 60% recommended chronic care, while about 30% of patients receive contraindicated acute care. The quality problems transcend the patient’s age, clinical condition, method of financing, and mode of care delivery. Relying on a growing body of research, quality experts have identified three other principal indicators of quality problems:
Error Rates. Inadequate diagnosis and treatment cause unnecessary mortality and morbidity, increasing the burden, complications, and cost of treatment.
An estimated 180,000 deaths are caused each year by medical error.
An estimated 30 percent of acute care patients and 20 percent of chronically ill patients receive care that is contraindicated.
Overtreatment. Millions of patients receive treatments each year that they do not need, leading to complications, reduced productivity, and significantly higher costs. Experts estimate that approximately 20 to 30 percent of healthcare treatments are unnecessary.
Overuse has been well documented for numerous types of invasive surgery and tests; an estimated 16 percent of hysterectomies and 17 percent of coronary angiograms performed each year are unnecessary.
Undertreatment. Studies consistently show the failure to provide effective treatments, ranging from life-saving interventions that can reduce mortality, such as taking aspirin to lower the risk of heart attack, to vaccinations that prevent serious illness in the elderly and children.
Only an estimated 50 percent of patients receive recommended preventive care.
Among individuals suffering from depression, 59 percent are not treated and 19 percent receive ineffective treatment, leading to an estimated $12 billion annual loss in employee productivity.
In operational terms, high quality healthcare is care that is known to be efficient; to be effective and to produce better health outcomes, greater patient functionality, and improved patient safety; and that is easy to access resulting in a satisfying experience for all concerned—i.e., care that is consumer-focused, safe, effective, efficient, and equitable.
The realization that the quality of healthcare in the United States falls short of what it could and should be is not new; neither is the recognition that meaningful progress to improve the quality of U.S. healthcare can be best made when all stakeholders work together. Until now, however, an organizational infrastructure and systematic framework to move forward in achieving these goals have been lacking.
By standardizing healthcare quality measures the compliance burden on healthcare providers will be reduced and the measures will become more useful. Standardized evidence-based measures will be more helpful to quality improvement efforts and will facilitate competition based on quality, promote consumer choice, and inform public policy.
The establishment of the NQF as a unique public-private partnership represents an important step forward, as it provides an equitable mechanism for all stakeholders—i.e., consumers, caregivers, institutional providers, health plans, payers, and research and quality improvement organizations—to develop a common vision for healthcare quality measurement, reporting, and improvement.