Measuring quality; A key to population health improvement

Public health practice and health care delivery in the United States share a common goal: longer, healthier lives for all. Quality in health care is essential for achieving this goal and is a central focus of implementing the Affordable Care Act, but the notion of quality in the public health system and more broadly in the multisectoral health system-public health, health care, and other partners-has received less attention. Identifying measures of quality for the health system just described is essential to the work of assessment and quality improvement, and for demonstrating accountability throughout the system. The Institute of Medicine report Toward Measures of Quality for Population Health and the Leading Health Indicators (LHI) examined how the Healthy People 2020 LHI could be used as a starting point for a portfolio of quality measures for population health. The committee outlined essential ingredients needed to establish a reasonable set of quality measures that could be used by a wide range of partners working to improve the health of communities. The Three-Part Aim is an important framework for health care in the United States, and one that is central to all HHS efforts to improve quality in health care. The Aim refers to better care, healthy people and communities, and reduced cost of care. Evidence-based measures of quality are needed to support the implementation of the Three-Part Aim, and although a great deal of effort is expended to do so in the health care delivery realm, increased recognition of and action on non-clinical factors or conditions that influence health outcomes call for greater attention to measures related to the "healthy people and communities" component of the aim. The IOM committee's approach to developing quality measures and using them consistently can help bring the efforts of stakeholders into alignment and spur progress toward achieving the "healthy people and communities" component of the Three-Part Aim. To this end, the committee recommended that HHS convene stakeholders to facilitate the use of measures of quality for the multisectoral health system and their integration into all activities under the Three-Part Aim with a special focus on the social and environmental determinants, equity, and the concept of total population health.