Quality of care problems are found in all regions of the United States, in small and large communities, and in fee-for-service and managed care systems alike. A key goal of the 1999 and 2000 Building Bridges Conferences, sponsored by the Agency for Healthcare Research and Quality, was to bridge the gap between scientific evidence about methods for improving quality of care with health care practice and policy.
Both conferences convened health services researchers, health plan representatives, clinicians, and Federal and State policymakers to focus on use of health services research to drive quality improvement. The December 2000 supplement to Medical Care Research and Review (volume 57, number 2) presents articles drawn from presentations at the two conferences.
Several articles address health care organization, delivery, and payment issues related to quality of care. They provide a snapshot of select activities being implemented by health plans, clinicians, and employers. Other articles develop and refine an agenda for future research. Four articles contributed by AHRQ staff and AHRQ-supported researchers are summarized here.
Brach, C., Sanches, L., Young, D., and others, "Wrestling with typology: Penetrating the 'black box' of managed care by focusing on health care system characteristics," pp. 93-115.
Recognizing the problems associated with continued use of out-of-date typologies, these authors present a new approach to describing the health care system—a matrix of organizational and delivery characteristics. The matrix includes a description for each key role in the health care system (i.e., sponsor, plan, provider intermediary organization, and direct services provider) of financial and structural features, as well as care delivery and management policies and product lines. It suggests a new set of players to be studied, emphasizes the relationships among players, and provides a checklist of variables to be included in research analyses.
Reprints (AHRQ Publication No. 01-R014) are available from the AHRQ Publications Clearinghouse.
Fraser, I., and McNamara, P., "Employers: Quality takers or quality makers?" pp. 33-52.
This review of research on employers' purchasing practices finds there is little evidence that employers are using their market leverage to assure or improve quality. And when they do, the quality indicators most frequently used probably are not the ones that clinical experts would select as most reflective of clinical quality. The authors conclude that employers as a group may be becoming more informed quality takers but not quality makers.
Reprints (AHRQ Publication No. 01-R012) are available from the AHRQ Publications Clearinghouse.
Hermann, R.C., Leff, H.S., Palmer, R.H., and others, "Quality measures for mental health care: Results from a national inventory," pp. 136-154 (AHRQ grant HS10303).
Quality of care measures are particularly underdeveloped in the area of mental health. This paper analyzes 86 process measures that have been developed to assess the quality of mental health care. Most measures evaluate treatment of major mental disorders, for example, schizophrenia and major depression, with a few focusing on children or the elderly. Domains of quality include treatment appropriateness, care continuity, access, coordination of care, disease detection, and disease prevention.
Scanlon, D.P., Rolph, E., Darby, C., and Doty, H.E., "Are managed care plans organizing for quality?" pp. 9-32 (AHRQ grant HS09204).
Interviews with leaders of 24 health plans revealed that MCOs are responding to outside pressures, particularly from Medicare and Medicaid, to engage in processes that improve the quality of care they provide. MCO governing boards are assuming an oversight role for quality improvement, dedicated senior staff have explicit responsibility for quality improvement, and practicing physicians are helping set medical policy. MCOs are also slowly building their technical capacity to collect and use information for quality improvement.
Reprints (AHRQ Publication No. 01-R013) are available from the AHRQ Publications Clearinghouse.
The supplement, "Contributions from the Field: Informing Quality Improvement," includes articles that provide insights on organizational and institutional approaches to quality. The articles also inform AHRQ's future research agenda related to quality by identifying evidence gaps, offering design suggestions, and implicitly identifying research priorities.
In addition to the articles authored by AHRQ staff or funded by the agency, the supplement includes the following articles:
The annual Building Bridges meeting began in 1995 as a collaborative effort between the American Association of Health Plans and the Agency for Healthcare Research and Quality, with the Centers for Disease Control and Prevention joining the partnership in 1998 and the Blue Cross Blue Shield Association joining in 1999. The purpose of the meetings is to bring together managed care researchers both outside and within managed care organizations to examine critical issues related to quality, access, and costs of managed care.
Copies of the new supplement (Medical Care Research and Review, volume 57, supplement 2, 2000, AHRQ Publication No. OM 01-0003) are available from the AHRQ Publications Clearinghouse.
Mark your calendars now for the 2001 meeting, "Building Bridges VII: Assessing Policy Decisions and their Impact on Health Care Delivery," which will be held April 26-27, 2001, in Seattle, WA.
For more information about the 2001 meeting, visit the AAHP Web site (http://www.aahp.org). Two AHRQ initiatives, the Healthcare Cost and Utilization Project (HCUP) database and the Consumer Assessment of Health Plans Survey (CAHPS®), will be featured in a meeting workshop.