iom principles for quality healthcareBlog

iom principles for quality healthcare

After all, how can you put numbers to a standard of excellence? Healthcare among many other industries is always in need of improvement. T – Timely Care: Patient care will be delivered in the most timely manner possible. Below are examples of quality measures in healthcare for each of IOM’s three categories, or domains. This addition to IHI’s planned quality improvement activities could foster an evidence base that better documents overall progress to achieve health equity.

Health care organizations could adopt pledges to act, as well as develop and test new assessment instruments. For most organizations, measuring the quality of anything can be difficult. An integrated measure of health literacy, language access, and cultural competence would help participating hospitals and health systems consider new activities to implement, and demonstrate their commitment to improving all three foundational care domains.Families USA, a leading national health consumer organization, issued a 2017 Call to Action for Health Equity Leaders that recommends more health equity leadership in payment and other reforms within the health care delivery system [29]In 2018, Families USA announced a Health Equity Task Force for Delivery and Payment Transformation. It has yet to be determined how many providers completed and reported on any of these four Achieving Health Equity Improvement Activities in MIPS.In the future, integrated measures of health literacy, language access, and cultural competence could be proposed to, and adopted by, CMS as MIPS Improvement Activities [16]. The NCQA work was commissioned by the Roundtable on Health Literacy of the National Academies of Sciences, Engineering, and Medicine [1]. In response to suggestions of workshop participants, NCQA revised its paper. The following section briefly describes the highlights of that revised paper [1].Initially, NCQA suggested that health literacy, language access, and cultural competence initiatives are potential cornerstones for higher-quality care among diverse and at-risk populations at the nation’s hospitals and medical centers. The authors suggest that a solution is to develop integrated measures with enough items to assess domains with empirical validity or retain some carefully selected, individual domain measures that are implemented along with integrated measures of health literacy, language access, cultural competence, and other patient-centered initiatives.Finally, any approach to measures of health literacy, language access, and cultural competence should include specific strategies to reach diverse and at-risk populations. One of these measures suggests “adopting and implementing a culture of equity.”Since the NQF Roadmap identifies health literacy, language access, and cultural competence as important topics for measurement, an integrated measurement approach would be aligned with the Roadmap’s call for prioritized measures to implement its proposed measurement framework. More specifically, language access and cultural competency efforts focus on racial, ethnic, or linguistic minorities, whereas health literacy efforts target a broad array of patients to improve quality. IOM is committed to promoting the highest ethical standards among its vendors. They are inextricably linked, yet it is challenging to rigorously assess how these three domains contribute to improved health equity, reduction of health disparities, and patient-centered high-quality care.Integrated approaches to fulfilling the aspirations of a monitoring system have yet to be developed, perhaps as a result of real and anticipated burdens in doing so. An integrated measure may or may not be sufficiently granular to provide needed information. Consolidating this fragmented approach and ensuring that it is measuring the aspects of care that matter in improving health literacy, language access, and cultural competency is critical to delivering an appropriate standard of care to all Americans.The development of integrated quality performance measures for three domains—health literacy, language access, and cultural competence—was proposed at a 2015 workshop of the Roundtable on Health Literacy of the National Academies of Sciences, Engineering, and Medicine [9].The Roundtable commissioned the National Committee for Quality Assurance (NCQA) to prepare a paper that would (1) identify measures of quality performance that assessed the three domains, (2) note any linkage or integration of the three domains, and (3) describe how the measures could be used to improve health care quality and the patient-consumer experience of care—especially among diverse and at-risk populations.

The latter barriers are coupled with a challenging, rapid expansion to payment models that are value-based, which changes the procedures under which health care organizations are paid by public and private health insurers.As a result, NCQA suggested that an integrated measure might be more warmly received if it was part of a broader strategy to enhance patient-centered care (and its evaluation) within health care organizations.Specifically, the NCQA paper proposed a broader patient-centered framework intended to address seven domains within health care organizations. Quality measures are easier to understand when organized into an accepted framework. In addition, NCQA noted they were unable to find an evaluation instrument that simultaneously assessed health literacy, patient/caregiver language access needs, and cultural competence initiatives provided to diverse, at-risk, or other populations within health care settings. A landmark in the quality movement in health care has been the publication of the Institute of Medicine’s (IoM) report ‘To err is human: building a safer health system’ in 1999 . For example, many state Medicaid programs and commercial payers continue to develop and implement models of accountable care that share savings based on quality improvement and cost reduction targets [18].In September 2017, the National Quality Forum (NQF), the leading endorser of health care quality measures through a national stakeholder consensus process, issued its Roadmap for Promoting Health Equity and Eliminating Health Disparities and launched its Health Equity Program [19, 20]. We support the continued use of specific measures, e.g., assessing organizational system responses to health literacy, or actual availability of needed language access services such as qualified interpreters, as part of overall efforts to maintain quality and accountability.Moreover, we believe that by integrating measurement activities across multiple dimensions of vulnerabilities—that frequently exist in tandem—health care organizations and providers will gain the tools to identify opportunities for quality improvement, and adapt care to meet diverse patients’ complex needs.

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