![]() health care system is the lack of standardized performance measures that enable cross-institutional comparisons.( 20) She stated that this creates two problems: "First, we do not know where the best performers are. Corrigan has written that one of the systemic problems with the current U.S. Janet Corrigan, the current President and CEO of NQF, worry that the field of quality measures is getting crowded and confusing.( 17) Dr. Features of the Safe Practice measures themselves, such as their low level of complexity or alignment with other salient patient safety measurement schemes-for example, mandatory Joint Commission accreditation-may promote adoption regardless of hospitals' geographic location, size, or other structural characteristics.( 13-16)Īlthough the Safe Practices have been generally agreed upon by most stakeholders and have served as a unifying force, the current proliferation of other measures of quality and safety has convinced AHRQ, NCQA, CMS, JCAHO, and NQF to try to remedy the situation.( 17-19) Experts like Dr. ![]() ![]() In contrast, research shows that some Safe Practices lack significant barriers to implementation. The barriers to adoption for these Safe Practices seem to be related to small hospital size, rural location, staffing shortages, and the lack of financial resources-constraints that may be ameliorated by economies of scale or certain models of health system management/ownership. For example, we have found that certain of the original 30 Safe Practices are not applicable due to resource barriers in some hospitals.( 13) Lower Safe Practice adoption rates are seen for resource-intensive practices such as implementing a computerized prescriber order entry system, ICU intensivist staffing, comprehensive pharmacist involvement in medication management, and referral of patients to high-volume hospitals. However, NQF's mandate to find universal, "one-size-fits-all" measures may not be ideal. Safe Practice updates were released in 20.( 12) NQF continues to use a consensus-based review process to update the original 30 Safe Practices, based on the latest evidence for existing and proposed practices. These 30 Safe Practices were deemed to be universally applicable in clinical care settings to reduce the risk of harm to patients.( 10, 11) It should be noted that a key characteristic of NQF's role in promoting safe practices is that the organization does not develop measures rather, it is a neutral body that endorses measures. In 2003, NQF utilized a formal consensus development process to identify and release a list of 30 nationally recommended, evidence-based "Safe Practices" from a pool of 220 candidate safe practices. These core measures would provide a foundation for reporting systems that facilitate the capture of quality and patient safety practices critical to the prevention of medical errors, thereby supporting continuous improvement efforts throughout the United States.( 7-9). Since NQF's inception, the Institute of Medicine (IOM), federal task forces, and major stakeholders have recommended that it be tasked with managing a set of standardized quality measurements. Kizer, NQF's first CEO and President, notes that NQF was structured as a unique public–private collaborative organization with a mission to promote the delivery of high-quality health care. The NQF, which was established in May 1999 by a White House–convened planning committee facilitated by then-Vice President Albert Gore ( 6), represents the culmination of this vision. President Clinton's 1996 Advisory Commission on Consumer Protection and Quality in the Health Care Industry envisioned an entity that would be responsible for (i) implementing a comprehensive plan for measurement and reporting, (ii) identifying core metrics for measurement and reporting, and (iii) promoting the development of the core measures. This is where the National Quality Forum (NQF) is playing an increasingly important role. The result: efforts to improve the efficiency, effectiveness, equity, timeliness, safety, and patient-centeredness of health care delivery services have been hindered by the lack of universally accepted measures. Recognizing that progress in improving quality and safety hinges on the availability of robust measures, many stakeholders have developed and disseminated a variety of quality measurement and reporting mechanisms in a piecemeal manner. Despite this attention, the rate of improvement has been slow.( 1-5) Although there are a number of contributors to this slow rate of progress, one factor is the lack of a uniform national quality measurement and reporting system. Over the last decade, considerable attention has focused on addressing deficiencies associated with health care quality and patient safety performance in the United States.
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