- Email: [email protected]
Public policy
Public Policy National Quality Forum, An Experiment in Democracy
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XPENDITURES for health care, the largest domestic enterprise in the United States at $1.3 trillion per year, continue to grow disproportionately to the rest of the economy. Although it is important to everyones’ lives, little is known about health care quality. What is known, including the contribution of nursing to quality health care, shows that health care quality problems are common, serious, largely preventable, and systemic in nature, transcending the method of care delivery or financing (Kizer, 2003). Creating a sense of urgency for quality improvement in recent years, warnings of the need for vigilance and action have come from many sources and have attracted the attention of the public, policy makers, and health professionals alike. A new book, Wall of Silence (Gibson & Singh, 2003), and recent newsworthy articles (McGlynn, et al. 2003; Burwen, et al. 2003) have added to the “call to arms.” A variety of important efforts have been launched in recent years to remedy the nation’s health care quality problems. One of the most promising of these is the National Quality Forum (NQF), a unique public-private venture about which everyone involved in health care should know. The NQF, established in 1999, is a private, nonprofit, open membership organization whose purpose is to catalyze increased provision of high-quality health care. The idea of creating a private-sector organization to promote a national agenda for health care quality measurement and quality improvement was promulgated by the President’s Advisory Commission on Consumer Protection and Quality in the Health Care Industry (1998). The effort to formally establish the NQF was initiated by the National Quality Forum Planning Committee, convened by former Vice President Al Gore in late 1998. The mission of NQF is to improve American health care by endorsing consensus-based national standards for measurement and public reporting of health care performance data that provide meaningful information about whether
NORMA M. LANG, PHD, RN, FAAN, FRCN Lillian S. Brunner Professor in Nursing University of Pennsylvania School of Nursing 420 Guardian Dr Philadelphia, PA 19104 E-mail: [email protected]
KENNETH W. KIZER, MD, MPH President and Chief Executive Officer The National Quality Forum 601 13th St NW, Suite 500 North Washington, DC 20005 E-mail: [email protected] © 2003 Elsevier Inc. All rights reserved. 8755-7223/03/1905-0000$30.00/0 doi:10.1053/S8755-7223(03)00125-X
care is safe, timely, beneficial, patient-centered, equitable, and efficient. The NQF is unique in both its governance structure and method of operation (Kizer, 2001). The NQF is categorized as a voluntary consensus standards setting organization in accordance with the National Technology Transfer Advancement Act of 1995 and the federal Office of Management and Budget Circular A-119 (Pub L; US Office of Management and Budget, 1998). This means that the NQF has a formal and equitable process for achieving consensus among health care’s disparate stakeholders. This is significant in that, when the federal government promulgates standards in an area, it is obligated to use voluntary consensus standards in lieu of government-unique standards except when inconsistent with law or otherwise impractical. The NQF membership is broad based, composed of four councils (consumers, health care providers and health plans, purchasers, and research and quality improvement organizations) that include nearly 200 organizations. The American Nurses Association has been an active member since the inception of NQF and is a member of the Health Care Provider Council. The NQF Board is composed of 23 voting and 6 liaison members, although the distinction between voting and nonvoting members is generally slight. In May 2003, Norma Lang was appointed to the NQF’s Board based on the understanding that nursing is very valuable to the work to endorse quality of care performance measures in cancer care, nursing, heart disease, patient safety, and many other areas. One of the NQF’s early achievements was the development of a strategic Framework for a National Healthcare Quality Measurement and Reporting System (Ashton, 2003) (The NQF, 2002). This strategic framework provides a starting point for the tasks of selecting, endorsing, and updating scientifically valid measures for national use; dissemination; and partnering to ensure their use and implementation. Of immediate interest to all health care stakeholders, including the nursing profession, are health care performance measures and standards that the NQF has endorsed so far. It has a Web site, http://qualityforum.org, for information and publications. Notable projects include Serious Reportable Adverse Events, Safe Practices for Better Health Care, Hospital Care National Performance Measures, Nursing Home Care Performance Measures, Home Health Care Performance Measures, Diabetes Care National Consensus Standards, Cancer Care Quality Measures, Mammography Quality Standards, Cardiac Surgery, Child Health, Academic Health Center, and Standardizing Credentialing. Of special interest to nursing stakeholders is the NQF Nursing Care Performance Measures Project. The project aims to identify and endorse a set of evidence-based performance measures to evaluate the quality of nursing care and
Journal of Professional Nursing, Vol 19, No 5 (September-October), 2003: pp 247-248
247
248
LANG AND KIZER
to identify a framework for how to measure and report the quality of nursing care, as well as to identify and prioritize unresolved issues and research needs. A sense of urgency about health care quality on patient outcomes, workforce productivity, and health care costs caused leaders in the public and private sectors to create the NQF as a mechanism to bring about national change. It is a rare opportunity for an “experiment in democracy” to bring together all the stakeholders in health care, including national, state, regional, and local groups, representing consumers, public and private purchasers, employers, health care professionals, provider organizations, health plans, accrediting bodies, labor unions, supporting industries, and organizations involved in health care research or quality improvement. Using a formal consensus process, the NQF works to promote a common approach to measuring health care quality and fostering systemwide capacity for quality improvement. What are the contributions (performance measures) made by nurses and the state of the evidence underpinning those measures? Clearly, the academic and practice communities in nursing are major stakeholders and will continue to have much to offer to the NQF. References Ashton, C. M. (Ed.) (January, 2003). The strategic framework board’s design for a national quality measurement and reporting system. Medical Care, Supplement 41, No.1, I-1–I-89.
Burwen, D. R., Galusha, D. H., Lewis, J. M., Bedinger, M. R., Radford, M. J., & Krumholz, H. M. (June 23, 2003). National and state trends in quality of care for acute myocardial infarction between 1994-95 and 1998-1999. Arch Intern Med, 163, 1430-1439. Gibson, R., & Singh, J. P. (2003). Wall of silence. Washington, DC: LifeLine Press. A Regnery Publishing Company. Kizer, K. W. (September 12, 2001). Establishing health care performance standards in an era of consumerism. Journal of the American Medical Association, 286, 1213-1217. Kizer, K. W. (January, 2003). Putting the ideas into practice. (Editorial). Medical Care, Supplement 41, Number 1, I-87–I89. McGlynn, E. A., Asch, S. A., Adams, A., Keesey, J., Hicks, J., DeCristofaro, A., et al (June 26, 2003). The quality of health care delivered to adults in the United States. New England Journal of Medicine, 348, 2635-2645. The National Quality Forum. (2002). A national framework for health care quality measurement and reporting. Washington, DC: National Forum for Health Care Quality Measurement and Reporting. The President’s Advisory Commission on Consumer Protection and Quality in the Heath Care Industry. (1998). Quality first: Better health care for all Americans. Washington, DC: Department of Health and Human Services. Pub L No 104-113, Stat 15, USC 3701. US Office of Management and Budget. (1998). Circular No. 119 (Revised). Washington, D.C.: US Office of Management and Budget.
E
XPENDITURES for health care, the largest domestic enterprise in the United States at $1.3 trillion per year, continue to grow disproportionately to the rest of the economy. Although it is important to everyones’ lives, little is known about health care quality. What is known, including the contribution of nursing to quality health care, shows that health care quality problems are common, serious, largely preventable, and systemic in nature, transcending the method of care delivery or financing (Kizer, 2003). Creating a sense of urgency for quality improvement in recent years, warnings of the need for vigilance and action have come from many sources and have attracted the attention of the public, policy makers, and health professionals alike. A new book, Wall of Silence (Gibson & Singh, 2003), and recent newsworthy articles (McGlynn, et al. 2003; Burwen, et al. 2003) have added to the “call to arms.” A variety of important efforts have been launched in recent years to remedy the nation’s health care quality problems. One of the most promising of these is the National Quality Forum (NQF), a unique public-private venture about which everyone involved in health care should know. The NQF, established in 1999, is a private, nonprofit, open membership organization whose purpose is to catalyze increased provision of high-quality health care. The idea of creating a private-sector organization to promote a national agenda for health care quality measurement and quality improvement was promulgated by the President’s Advisory Commission on Consumer Protection and Quality in the Health Care Industry (1998). The effort to formally establish the NQF was initiated by the National Quality Forum Planning Committee, convened by former Vice President Al Gore in late 1998. The mission of NQF is to improve American health care by endorsing consensus-based national standards for measurement and public reporting of health care performance data that provide meaningful information about whether
NORMA M. LANG, PHD, RN, FAAN, FRCN Lillian S. Brunner Professor in Nursing University of Pennsylvania School of Nursing 420 Guardian Dr Philadelphia, PA 19104 E-mail: [email protected]
KENNETH W. KIZER, MD, MPH President and Chief Executive Officer The National Quality Forum 601 13th St NW, Suite 500 North Washington, DC 20005 E-mail: [email protected] © 2003 Elsevier Inc. All rights reserved. 8755-7223/03/1905-0000$30.00/0 doi:10.1053/S8755-7223(03)00125-X
care is safe, timely, beneficial, patient-centered, equitable, and efficient. The NQF is unique in both its governance structure and method of operation (Kizer, 2001). The NQF is categorized as a voluntary consensus standards setting organization in accordance with the National Technology Transfer Advancement Act of 1995 and the federal Office of Management and Budget Circular A-119 (Pub L; US Office of Management and Budget, 1998). This means that the NQF has a formal and equitable process for achieving consensus among health care’s disparate stakeholders. This is significant in that, when the federal government promulgates standards in an area, it is obligated to use voluntary consensus standards in lieu of government-unique standards except when inconsistent with law or otherwise impractical. The NQF membership is broad based, composed of four councils (consumers, health care providers and health plans, purchasers, and research and quality improvement organizations) that include nearly 200 organizations. The American Nurses Association has been an active member since the inception of NQF and is a member of the Health Care Provider Council. The NQF Board is composed of 23 voting and 6 liaison members, although the distinction between voting and nonvoting members is generally slight. In May 2003, Norma Lang was appointed to the NQF’s Board based on the understanding that nursing is very valuable to the work to endorse quality of care performance measures in cancer care, nursing, heart disease, patient safety, and many other areas. One of the NQF’s early achievements was the development of a strategic Framework for a National Healthcare Quality Measurement and Reporting System (Ashton, 2003) (The NQF, 2002). This strategic framework provides a starting point for the tasks of selecting, endorsing, and updating scientifically valid measures for national use; dissemination; and partnering to ensure their use and implementation. Of immediate interest to all health care stakeholders, including the nursing profession, are health care performance measures and standards that the NQF has endorsed so far. It has a Web site, http://qualityforum.org, for information and publications. Notable projects include Serious Reportable Adverse Events, Safe Practices for Better Health Care, Hospital Care National Performance Measures, Nursing Home Care Performance Measures, Home Health Care Performance Measures, Diabetes Care National Consensus Standards, Cancer Care Quality Measures, Mammography Quality Standards, Cardiac Surgery, Child Health, Academic Health Center, and Standardizing Credentialing. Of special interest to nursing stakeholders is the NQF Nursing Care Performance Measures Project. The project aims to identify and endorse a set of evidence-based performance measures to evaluate the quality of nursing care and
Journal of Professional Nursing, Vol 19, No 5 (September-October), 2003: pp 247-248
247
248
LANG AND KIZER
to identify a framework for how to measure and report the quality of nursing care, as well as to identify and prioritize unresolved issues and research needs. A sense of urgency about health care quality on patient outcomes, workforce productivity, and health care costs caused leaders in the public and private sectors to create the NQF as a mechanism to bring about national change. It is a rare opportunity for an “experiment in democracy” to bring together all the stakeholders in health care, including national, state, regional, and local groups, representing consumers, public and private purchasers, employers, health care professionals, provider organizations, health plans, accrediting bodies, labor unions, supporting industries, and organizations involved in health care research or quality improvement. Using a formal consensus process, the NQF works to promote a common approach to measuring health care quality and fostering systemwide capacity for quality improvement. What are the contributions (performance measures) made by nurses and the state of the evidence underpinning those measures? Clearly, the academic and practice communities in nursing are major stakeholders and will continue to have much to offer to the NQF. References Ashton, C. M. (Ed.) (January, 2003). The strategic framework board’s design for a national quality measurement and reporting system. Medical Care, Supplement 41, No.1, I-1–I-89.
Burwen, D. R., Galusha, D. H., Lewis, J. M., Bedinger, M. R., Radford, M. J., & Krumholz, H. M. (June 23, 2003). National and state trends in quality of care for acute myocardial infarction between 1994-95 and 1998-1999. Arch Intern Med, 163, 1430-1439. Gibson, R., & Singh, J. P. (2003). Wall of silence. Washington, DC: LifeLine Press. A Regnery Publishing Company. Kizer, K. W. (September 12, 2001). Establishing health care performance standards in an era of consumerism. Journal of the American Medical Association, 286, 1213-1217. Kizer, K. W. (January, 2003). Putting the ideas into practice. (Editorial). Medical Care, Supplement 41, Number 1, I-87–I89. McGlynn, E. A., Asch, S. A., Adams, A., Keesey, J., Hicks, J., DeCristofaro, A., et al (June 26, 2003). The quality of health care delivered to adults in the United States. New England Journal of Medicine, 348, 2635-2645. The National Quality Forum. (2002). A national framework for health care quality measurement and reporting. Washington, DC: National Forum for Health Care Quality Measurement and Reporting. The President’s Advisory Commission on Consumer Protection and Quality in the Heath Care Industry. (1998). Quality first: Better health care for all Americans. Washington, DC: Department of Health and Human Services. Pub L No 104-113, Stat 15, USC 3701. US Office of Management and Budget. (1998). Circular No. 119 (Revised). Washington, D.C.: US Office of Management and Budget.