In this paper we will discuss the reasons preventing access to quality health care and how we can overcome the many obstacles that stand in our way to provide quality health care to many who lack it today....
The Alliance for Health Reform and the Robert Wood Johnson Foundation sponsored this March 2012, reporters-only briefing to help journalists cover the Supreme Court arguments challenging the Patient Protection and Affordable Care Act and their aftermath with greater depth and understanding. Panelists focus on tips, story ideas and angles that have perhaps been underreported or overlooked, as well as angles for after the court ruling comes down, expected in June.
The purpose of this paper is to explore one of the many health care resources that are available in the greater Philadelphia area and then visit this site to learn more about it.
The purpose of this report is to provide information about the current status of performance measurement in the context of payment reform and to identify near-term opportunities for performance measure development. The report is intended for the many stakeholders tasked with outlining a national quality strategy in the wake of health care reform legislation.
The first in a series of reports, this paper presents a snapshot of health insurance coverage, health care use and barriers to care, and financial security at the start of ACA implementation.
Determining the group of relevant outcomes to measure for any medical condition (or patient population in the context of primary care) should follow several principles. Outcomes should include the health circumstances most relevant to patients. They should cover both near-term and longer-term health, addressing a period long enough to encompass the ultimate results of care. And outcome measurement should include sufficient measurement of risk factors or initial conditions to allow for risk adjustment.
The current organizational structure and information systems of health care delivery make it challenging to measure (and deliver) value. Thus, most providers fail to do so. Providers tend to measure only what they directly control in a particular intervention and what is easily measured, rather than what matters for outcomes. For example, current measures cover a single department (too narrow to be relevant to patients) or outcomes for a whole hospital, such as infection rates (too broad to be relevant to patients). Or they measure what is billed, even though current reimbursement practices are misaligned with value. Similarly, costs are measured for departments or billing units rather than for the full care cycle over which value is determined. Faulty organizational structure also helps explain why physicians fail to accept joint responsibility for outcomes, blaming lack of control over “outside” actors involved in care (even those in the same hospital) and patients' compliance.
Health care delivery involves numerous organizational units, ranging from hospitals to physicians' practices to units providing single services, but none of these reflect the boundaries within which value is truly created. The proper unit for measuring value should encompass all services or activities that jointly determine success in meeting a set of patient needs. These needs are determined by the patient's medical condition, defined as an interrelated set of medical circumstances that are best addressed in an integrated way. The definition of a medical condition includes the most common associated conditions — meaning that care for diabetes, for example, must integrate care for conditions such as hypertension, renal disease, retinal disease, and vascular disease and that value should be measured for everything included in that care.
Value should always be defined around the customer, and in a well-functioning health care system, the creation of value for patients should determine the rewards for all other actors in the system. Since value depends on results, not inputs, value in health care is measured by the outcomes achieved, not the volume of services delivered, and shifting focus from volume to value is a central challenge. Nor is value measured by the process of care used; process measurement and improvement are important tactics but are no substitutes for measuring outcomes and costs.
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Angela Coulter, Vikki A Entwistle, Abi Eccles, Sara Ryan, Sasha Shepperd, Rafael Perera, . . (2015) Personalised care planning for adults with chronic or long-term health conditions. 85.
G K R Berntsen, D Gammon, A Steinsbekk, A Salamonsen, N Foss, C Ruland, V Fønnebø. . (2015) How do we deal with multiple goals for care within an individual patient trajectory? A document content analysis of health service research papers on goals for care. 5, e009403.