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Since the passage of the Affordable Care Act, health care payers, purchasers, providers, and consumers have shown an increased commitment to health and health care quality.
The initial National Quality Strategy, published in March 2011, established three aims and six priorities for quality improvement (see Figure 1). The National Quality Strategy encourages efforts to identify and adopt unified measures that meet the reporting requirements of multiple programs and initiatives across the Federal Government, the private sector, States, and even individual health systems and providers. This report includes updates to the national tracking measures that align to each of the National Quality Strategy's six priorities and demonstrate national health and health care quality trends. The 2012 National Quality Strategy progress report identified three strategic opportunities for accelerating system-wide improvement across all of the aims and priorities; this report provides information on progress made against each.
Develop a national strategy for data collection, measurement, and reporting that supports performance measurement and improvement efforts of public- and private-sector stakeholders at the national and community level.
Public- and private-sector efforts to align measures are contributing to the development of a national strategy for collecting data, measuring improvement, and public reporting. There is also evidence of a growing community-level infrastructure to support quality improvement across the Nation. Finally, private and public payers are embracing a new perspective on health care payment and delivery—one that emphasizes value over volume and rewards providers that deliver high-quality care. The National Quality Strategy serves as a guiding force in the multitude of quality improvement efforts across the Nation, fostering alignment across national, Federal, State, and private sector stakeholders to improve health and health care quality for all Americans. The National Strategy for Quality Improvement in Health Care (National Quality Strategy) continues to inspire and guide a nationwide effort to coordinate public and private efforts to improve the quality of health and health care for all Americans. The National Quality Strategy encourages alignment of health and health care quality programs and performance measures across the country. This report provides an update on the Nation's progress improving quality across six priority areas, while also highlighting local examples of excellence that show what is possible. Promoting the most effective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular disease. Making quality care more affordable for individuals, families, employers, and governments by developing and spreading new health care delivery models.
The 2012 Annual Progress Report to Congress on the National Quality Strategy elaborated on these six priorities, and established long-term goals (see Figure 3) and national tracking measures to monitor quality improvement progress. A broad and robust stakeholder engagement process informed the choice of these priorities, long-term goals, and measures. Last year's progress report to Congress on the National Quality Strategy offered an in-depth look at the implementation activities taking place across the Federal Government.
A spotlight on unprecedented collaboration between public and private payers, leading to the establishment and adoption of a consensus set of core measures. New progress on reducing the burden of data collection for providers engaged in quality improvement. Private sector champions achieving excellence and sharing best practices in each of the six priority areas. A spotlight on the three strategic opportunities, reflecting the breadth of activity to improve quality infrastructure across the country.
Though this progress report only touches upon some of the robust quality improvement activities taking place across the Federal Government and the Nation, it is an encouraging survey of progress and engagement.
Performance measures allow us to gauge the quality of care provided, identify best practices for achieving desired outcomes, and identify opportunities for improvement.
New Consensus Among Public and Private Payers on Quality Measurement The Affordable Care Act required that multi-stakeholder groups provide input on the best performance measures for public reporting and performance-based payment programs. The Measures Application Partnership is helping HHS identify and prioritize the best performance measures. The involved parties, including Service Employees International Union (SEIU), American Federation of Labor—Congress of Industrial Organizations (AFL-CIO), IBM, Xerox, Aetna, Cigna, WellPoint, United Healthcare, and the national Blue Cross Blue Shield Association agreed to work together to implement this core set of measures in their programs as soon as possible.
As more public and private payers tie payment to health care quality, programs requiring data collection have proliferated.
Many CMS programs, such as the Physician Quality Reporting System (PQRS), Physician Value-based Payment Modifier, the Shared Savings Program for Accountable Care Organizations (ACOs), and the Electronic Health Record (EHR) Incentive Programs require reporting of quality measures by physicians and other eligible professionals. Other Federal agencies have taken similar steps to align measures and reduce the burden of reporting. Central to the National Quality Strategy are six priorities that focus national quality improvement efforts. Across the country, health care providers, payers, and communities have accepted the invitation of the National Quality Strategy to align care delivery, payment incentives, and local infrastructure to drive improvement—and they are achieving significant results.
Finally, this section includes aspirational targets for improvement for each of the national tracking measures. Everyone agrees that no patients should be harmed by the health care they receive and all clinicians should be empowered with the best tools and information to deliver safe, effective, quality care. 1 Agency for Healthcare Research and Quality (AHRQ), Centers for Disease Control and Prevention (CDC), and Centers for Medicare & Medicaid Services (CMS), 2010. 3 The target date for the Priority 1 measures was adjusted from 2013 to 2014, because the 3-year Hospital Engagement Network program, a key driver for improvement in these measures, did not begin until December 2011. Nationwide data from 2011 indicates the HAC rate is declining, and although the all-payer 30-day readmission rate isn't declining yet, recent data from the Medicare program is promising. High-quality care is not only safe; it is also timely, accessible, and consistent with individual and family preferences and values. 6 AHRQ, Center for Financing, Access, and Cost Trends, Medical Expenditure Panel Survey, 2010. 7 AHRQ, Center for Financing, Access, and Cost Trends, Medical Expenditure Panel Survey, 2010. Though updated nationwide data is not yet available on these two measures, local communities, private payers, and individual practices are improving the person and family experience of care in significant and innovative ways. In January 2011, Kaiser Permanente in Southern California implemented a shared decision-making pilot in three of its medical centers. Conscious, patient-centered coordination of care not only improves the patient's experience, it also leads to better long-term health outcomes, as demonstrated by fewer unnecessary trips to the hospital, fewer repeated tests, fewer conflicting prescriptions, and clearer advice about the best course of treatment. 8 Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau; CDC, National Center for Health Statistics, National Survey of Children's Health, 2007.
The Southcentral Foundation in Anchorage, Alaska, provides primary outpatient care to approximately 55,000 Alaska natives and American Indians using a team-based approach, recognized by the National Committee for Quality Assurance as a Level 3 Patient-Centered Medical Home™, the highest level achievable. 13 CDC, National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS), 2007–2008.
While there are slight declines in the rates for cholesterol management and smoking cessation in the table above, these changes are not statistically significant. 21 Substance Abuse and Mental Health Services Administration (SAMHSA), Office of Applied Studies, National Survey on Drug Use and Health, 2010. The national tracking measure for depression appears to be declining, but the change between the baseline rate and most recent rate is not statistically significant.
23 Available at Robert Wood Johnson Foundation Health Policy Snapshot: Childhood Obesity Issue Brief, September 2012. 24 Agency for Healthcare Research and Quality, Center for Financing, Access, and Cost Trends, Medical Expenditure Panel Survey, 2010. 25 See the HHS Budget in Brief for a discussion of investments and proposals to reduce health care spending.
28 See the HHS Budget in Brief for a discussion of investments and proposals to reduce health care spending.
Recent trends in national indicators of cost growth and individual affordability are very encouraging. Innovative new models of paying for health care are spreading rapidly nationwide and are beginning to yield results that will further drive down future costs.
30 Available at The Kaiser Family Foundation and Health Research and Educational Trust, Employer Health Benefits: 2012 Annual Survey, September 2012.
The 2012 National Quality Strategy progress report illuminated three specific approaches for accelerating system-wide improvement across all of the aims and priorities of the National Quality Strategy.
Develop an infrastructure at the community level that assumes responsibility for improvement efforts, resources for communities to benchmark and compare performance, and mechanisms to identify, share, and evaluate progress. To successfully drive quality improvement, these strategic opportunities will require engagement by both public- and private-sector partners, adoption of common goals across stakeholders, and the engenderment of shared accountability throughout the health care system. All payers, public and private, benefit from consensus on a national strategy for data collection, measurement, and reporting while ensuring the privacy and security of personally identifiable information. The ultimate goal is to allow providers to make health care decisions based on real-time data analysis using patient data reports and clinical decision support tools, such as computerized alerts and reminders. Empowered by new authority granted through the Affordable Care Act, CMS is providing unprecedented access to timely health care data in an effort to support performance measurement, quality improvement, and patient and family engagement. Additionally, CMS has created an ACO data sharing program in which participating Medicare ACOs receive monthly beneficiary-level claim feeds, currently helping approximately 250 ACOs better coordinate care for more than 4 million Medicare beneficiaries. Many health care organizations view the adoption of an EHR system with evidence-based clinical decision support capabilities as the first step to transforming their practices to provide consistently high-quality care across their communities. The Affordable Care Act directed HHS to support the transformation of health care financing and delivery away from reimbursement for volume of services and toward payment for the value of care delivered to beneficiaries. Most importantly, commercial and State-based programs that also support health care transformation are complementing these Federal payment and delivery system reforms. 33 Oregon Health Care Quality Corporation, Health Improvement Collaborative of Greater Cincinnati, Kansas City Quality Improvement Consortium, Maine Health Management Coalition Foundation, HealthInsight, California Healthcare Performance Information System. 35 Available at Benefits of Implementing the Primary Care Patient-Centered Medical Home: A Review of Cost and Quality Results, Patient-Centered Primary Care Collaborative, 2012. The National Quality Strategy is an adaptable and evolving resource to improve health, improve quality of care, and lower costs for all Americans.
There are many indicators of national progress on quality improvement, with each measure offering a different lens through which to view and understand progress. The effort to focus on measures that are the most relevant to clinicians, payers, and consumers can reduce the administrative burden of data collection and reporting. In the 3 years since the passage of the Affordable Care Act, the Nation has seen increasing interest and activity in health care quality improvement and delivery system reform. 1 See the HHS Budget in Brief for a discussion of investments and proposals to reduce health care spending.
In 1978 he entered the Government Economic Service as an Assistant Economist in the Department of Agriculture and Fisheries for Scotland. He was first elected as MP for Banff and Buchan in 1987 and was elected as National Convener for the Scottish National Party in 1990. He was re-elected as Leader of the SNP in 2004 and elected as MSP for the Gordon constituency in May 2007.
He won the Aberdeenshire East constituency at the May 5, 2011, election when the SNP won a majority of seats of in the Scottish Parliament and MSPs re-elected him unopposed for a second term as FM on May 18. When not working he enjoys horse racing, football - supporting Scotland and Heart of Midlothian FC - golf and reading.
Richard has played a formative role in international research on the social determinants of health and on the societal effects of income inequality. Professor Charles W Munn was chairman of the Church of Scotland Special Commission on the Purposes of Economic Activity 2010-2012. Sally Foster-Fulton is Associate Minister at Dunblane Cathedral and Convener of the Church and Society Council for the Church of Scotland.
Phil Hanlon was educated in the West of Scotland and graduated in medicine from Glasgow University in 1978. Likes: The countryside, cycling, walking, bird-watching and wildlife, reading and when time permits theatre, concerts and cinema. Stuart Allan was educated at Morgan Academy and then graduated in law from the University of Dundee in 1970. He enjoyed a distinguished career in local government (including Moray and Nairn Joint County Council, Highland Regional Council, Fife Regional Council and Fife Council) latterly being Director of Corporate Services and Head of Law and Administration.
During his career he has acted as an adviser to a number of organisations including COSLA, the Scottish Office and the Assembly of European Regions. He has also acted as Returning Officer and Regional Returning Officer at local government, Parliamentary, Scottish Parliamentary and European elections. In 2001, he was appointed the first Chief Investigating Officer under the Ethical Standards (Scotland) Act and in 2009, he was appointed by the Parliament to be the Scottish Parliamentary Standards Commissioner.
In 2011, he was appointed as the first Public Standards Commissioner for Scotland (which took over the functions of the Chief Investigating Officer and the Scottish Parliamentary Standards Commissioner). He is also member and chair of the Commission for Ethical Standards in Public Life in Scotland. Alison Phipps is Professor of Languages and Intercultural Studies, and Co-Convener of Glasgow Refugee, Asylum and Migration Network (GRAMNET). Margo MacDonald has been an Independent list MSP for Lothians since 2003, and was a SNP list Member from 1999.
A former Chief Executive of Network Scotland, Margo devised and set up Drugline, Smokeline, NHS Patients' Helpline, and managed and re-organised the National AIDS Helpline.
Margo worked as a broadcaster with Radio Forth from 1981-85 after which she presented and reported for the BBC, Channel 4 etc. Margo was Director of Shelter Scotland 1978 – 1981 prior to which she worked as a writer and broadcaster. Human performance under simulated lunar lighting conditions: is it possible to walk on the moon?
Does intracrine amplification provide a unifying principle for the progression of common neurodegenerative disorders? The ability to communicate information and ideas effectively is increasingly recognized as critical to the success of the healthcare system.
The health care system and science communication overall can be made more accessible to individuals using a range of strategies including critically reflecting on assumptions. The ability to communicate ideas effectively is increasingly recognized as critical to the success of the healthcare system. Many points in the health care system require effective knowledge transfer between health care providers and consumers.
Those who enter the formal health care system as patients must make even more decisions within a complex system that can be difficult for individuals to navigate (2).
More than half of Canadians have difficulty understanding and using health information (6). In a culturally diverse society, challenges to health and functional literacy are only exacerbated. Despite the important roles health literacy and patient communication play in the effectiveness of health care overall, there are few requirements to teach information on health literacy in professional schools. Exploration of the effectiveness of communication between health care professionals themselves (interprofessional communication) offers additional insights into communication challenges and opportunities.
Challenges currently faced in interprofessional communication can be related to the development of language specific to each profession. Skills that enable communication between health care professionals traditionally are not taught to students (1). For those working in health care or the sciences, these challenges present important opportunities for future practice.
Although some factors (age, income, language) can predict low literacy and health literacy, many individuals with average or high skills are still challenged to interpret health information (22). Communication techniques known to improve understanding include engaging consumers in their role in health care and promoting shared decision making, reviewing information with them (especially written materials), and encouraging questions and discussion (23). Another important method is the ‘teach-back’ or ‘show-back’ technique, in which the provider asks the consumer to teach back the information from the health care encounter in different words. There are several standardized tests that can be used to evaluate literacy and health such as the TOFHLA (Test of Functional Health Literacy in Adults) and the Rapid Assessment of Adult Literacy in Medicine (24). Several single item literacy screening questions appear effective in identifying literacy and health literacy skills (25). The inability to provide culturally sensitive health information to minority populations has most certainly contributed to disparities in health care (12). The Kleinman questions (26) provide eight questions that can be used in practice to identify personal meaning for health and wellness (12). Incorporating these questions into general discussion, history taking or other opportunities in a health exchange can provide a wealth of information for all recipients of health information.
Careful consideration of how to communicate most effectively to audiences with varying needs underpins the translation of research findings into practice (28). The ability to successfully communicate ideas to individuals with differing roles, abilities and priorities is recognized as an enabler to the effectiveness of healthcare overall. Fortunately, there are strategies to promote more effective communication that everyone can use including: awareness of jargon, consideration of how to make information most meaningful and challenging one’s own assumptions. All works published in Hypothesis are open access, subject to the terms of the Creative Commons Attribution License.

The National Strategy for Quality Improvement in Health Care (National Quality Strategy) establishes a framework for coordinating and focusing the significant efforts of these diverse stakeholders to improve the quality of health and health care for all Americans.
The National Quality Strategy's first annual progress report to Congress, published in April 2012, elaborated on these six priorities and established long-term goals and national tracking measures to monitor quality improvement progress. Measure alignment allows stakeholders to gauge performance outcomes, while also creating continuity and consistency for providers and consumers.
Furthermore, the Federal Government is taking unprecedented steps forward in sharing appropriate data with clinicians who are undertaking quality improvement efforts and with consumers making care decisions. Communities continue to recognize the role of health and non-health care stakeholders alike in promoting better health and health care quality, and use a variety of tools, such as health information technology, to support better health and health care for their community members. In the few years since the passage of the Affordable Care Act, a growing number of stakeholders are increasing their emphasis on health and health care quality improvement, yielding promising returns and evidence of a health system transformation underway.
The National Quality Strategy serves as a resource for identifying and prioritizing quality improvement efforts, sharing lessons learned, and measuring the collective success of Federal, State, and private-sector health care stakeholders across the country. The past year has seen significant advancements in patient safety research and improvement, adoption of new care delivery models rewarding quality improvement, public-private alignment of data collection and measurement, and a decrease in cost growth across the American health care system.
The 2012 progress report also highlighted three strategic opportunities for improvement, which cut across all six priority areas to support ongoing innovation and improvement. This year's progress report focuses on overall quality improvement, while also offering new granularity and focus in some of the priority areas. Since the passage of the Affordable Care Act, performance measurement has become increasingly important. HHS contracted with the National Quality Forum to convene the Measures Application Partnership, a consensus-based entity composed of over 60 public- and private-sector organizations representing consumers, businesses and purchasers, labor, clinicians, hospitals, and Federal partners.
In October 2012, the group began meeting with Federal agencies, including the Centers for Medicare & Medicaid Services (CMS) and the Agency for Healthcare Research and Quality (AHRQ), to discuss an approach for developing common performance measures for value purchasing among public and private payers, and leveraging work by the Measures Application Partnership.
In 2013, Buying Value seeks increased adoption of the core measure set by local and regional purchasing coalitions, and the increased use of electronic measures, including those that have been selected for the EHR Incentive Programs.
While these initiatives appropriately focus the attention of health care providers on quality outcomes and improvement, they also require effort and infrastructure to provide clinically relevant evidence-based guidelines at the point of care, standardized multipurpose data collection, and interoperable data transmission. Established in various statutes at different times, these programs often have different quality reporting requirements.
The same measures that hospitals report for the Hospital Inpatient Quality Reporting (IQR) program are posted on Hospital Compare, and the Hospital Value-Based Purchasing program uses a subset of these IQR measures.
In 2012, the Health Resources and Services Administration (HRSA) established the Measures Management Review Board to harmonize and align measures across HRSA to promote the use of nationally recognized measures, such as those endorsed by the National Quality Forum and used in the CMS EHR Incentive Programs and PQRS. In 2012, HHS established a Measurement Policy Council (MPC) to ensure ongoing harmonization of measures across agencies and programs. Established in 2011 after significant stakeholder input, the six priorities now guide public and private investments in quality improvement.
This section highlights select communities and health systems that have shown dramatic improvement in each priority area and, in some cases, insights from those leaders about how to replicate their success. Aspirational targets for patient safety (priority area #1) and cardiovascular health (priority area #4) were established last year to align with the goals of the Partnership for Patients and the Million Hearts® Initiative. Eliminating infections, falls, and other harms in health care settings is fundamental to improving quality. Among Medicare patients, who represent approximately 58 percent of all hospital readmissions, the hospital readmission rate decreased in 2012. The Irving, Texas-based VHA cooperative of nonprofit hospitals reduced all-payer, all-cause readmissions by 17.6 percent in just 12 months across 192 hospitals. Individuals stay healthier when they and their families are actively engaged in their care, understand their options, and make choices that work for their lifestyles. Patients diagnosed with osteoarthritis of the hip or knee were offered video-based decision aids to help them identify their treatment goals and navigate the various care options based on their values and preferences.
Quality language assistance services and the adoption of electronic health records make it easier for clinicians to effectively communicate with patients across settings, and new models of care delivery and payment, such as patient-centered medical homes and ACOs, are giving providers shared incentives to work together to keep patients healthy. The Foundation's small, integrated, primary care teams include a physician, one or two medical assistants, a full-time nurse focused on care coordination, an administrative assistant to provide case management support, and often a behaviorist. The successful efforts of the Million Hearts Initiative, as well as numerous other public- and private-sector efforts, suggest that the rates will show improvement over time. Access to healthy food, preventive services, and physical exercise are all vital to maintaining overall health and preventing painful and costly medical complications.
Due to the increased coverage of mental health services under the essential health benefits provisions of the Affordable Care Act, we expect this measure to show improvement over time. Moreover, quality improvement often goes hand in hand with cost savings for both payers and consumers. Private payers are increasingly implementing payment models similar to the Medicare ACOs, which hold providers accountable for improving quality and lowering the rate of growth in expenditures for an assigned patient population. These three strategic opportunities are based on input provided by the National Priorities Partnership, a group of national health care stakeholders. Though this level of coordination and collaboration is rare in health care, remarkable progress to date on these three strategic opportunities are cause for hope and further inspiration.
The ongoing work and significant progress in that effort is described in Section 2 of this report. To that end, the HHS Office of National Coordinator for Health IT will release a health IT-focused quality improvement strategy that aims to coordinate evidence-based guidelines, clinical decision support tools, and electronic clinical quality measures. Qualifying entities that participate in the Medicare Data Sharing for Performance Measurement program are now eligible to receive previously restricted Medicare data to measure provider performance. However, providers across the Nation face similar hurdles to successfully implementing EHRs. To that end, HHS offers more than three dozen opportunities for providers across the care spectrum to participate in pilot programs to improve quality and reduce the cost of care.34 Examples of these programs include Bundled Payments for Care Improvement, Strong Start for Mothers and Newborns, and Health Care Innovation Awards.
For example, Horizon Blue Cross Blue Shield of New Jersey has shown improved quality and reduced costs through its patient-centered medical home initiatives.
A Collaborative Accountable Care Model In Three Practices Showed Promising Early Results On Costs And Quality Of Care. The national tracking measures for each of the six National Quality Strategy priority areas were chosen to give the broadest possible view of national quality improvement. HHS will continue to pare down and consolidate the measures that providers are required to collect and report. There is a growing body of evidence on how to keep patients safer, how to best coordinate care to improve outcomes, and how to lower costs through improvement. Department of Health and Human Services (HHS) Measures Inventory throughout 2012 and reached a consensus on the following measures in the areas of hospital-acquired conditions (HAC), hypertension control, care coordination, patient experience, smoking cessation, and depression screening.
He attended Linlithgow Academy before studying at St Andrews University, where he graduated with a joint honours MA in Economics and History. In 1980 he joined the Royal Bank of Scotland where he worked for seven years: first as an Assistant Economist before being appointed Energy Economist in 1982 and, from 1984, Royal Bank Economist.
He served as leader of the opposition in the Scottish Parliament when he was elected MSP for Banff and Buchan Constituency in 1999.
He also writes business history and recently completed a history of the Airdrie Savings Bank. The Church and Society Council is responsible for facilitating interface between the Church of Scotland and wider civic society. He was then promoted to Colonel and served for 3 years in the Ministry of Defence in the Military Operations Directorate.Promoted to Brigadier in 1998, he commanded the 52nd Lowland Brigade based in Edinburgh Castle. He was a member of the Working Group dealing with the Internal Management of Local Authorities set up for the purpose of the last re-organisation of local government. In June 2012 he was also appointed as acting Public Appointments Commissioner for Scotland. She is a member of the Creativity, Culture and Faith group in the School of Education at the University of Glasgow where she teaches languages, religious education, anthropology and intercultural education and education for non-violence. She was MP for Govan 1973 – 1974 before and after which she combined the roles of barmaid and mother.
For the first time in their history, Assistants are starting to get the recognition that they deserve as strategic business partners and not just as a support mechanism. Effective communication is required not only for successful interactions between individuals and their health care providers but also between health care providers themselves. In this article, several root causes of difficulty in communication will be discussed, and practical suggestions given to enable more effective communication of ideas between individuals with differing backgrounds in the health care system. Effective communication is required not only for successful interactions between individuals and their health care providers (1) but also between health care providers themselves.
Within hospitals, they may be challenged to communicate with a large number of health care professionals and have to make difficult treatment decisions. Sixty percent have low levels of health literacy, defined as the skills required to access and use health information to make vital health care decisions and maintain basic health (6). Almost half of Canadians have low functional literacy, the reading and writing skills needed to cope with the demands of everyday life. Barriers to accessing information are widely reported among minority groups, often resulting in less participation in health promotion and inefficient utilization of the health care system (11). The topic of patient communication rarely systematically addresses this important area in schools of medicine, public health, nursing, dentistry, or pharmacy (2). Interprofessional communication is critical to enabling the effectiveness of the health care system as the costs associated with ineffective communication between heath care professionals are very high. This can pose challenges for communication across professions if providers are unable to understand or lack a shared understanding of key acronyms, jargon and concepts. Yet there is evidence that this is changing through the growth of interprofessional education efforts and the identification of interprofessional communication as a critical core competency needing to be addressed in health studies curricula (19). Increasingly, the need for those working in the sciences to be understood by consumers and other professionals requires the use of effective communication. This allows the provider to assess and ensure consumer comprehension in a more thorough manner than asking ‘Do you understand?’ This can be especially important in encounters where informed consent is sought and it is imperative the consumer has a clear understanding of the risks and benefits.
However, these tests take between 3-12 minutes on average to administer, which can be cumbersome. One question, ’How confident are you filling out medical forms by yourself?’ was more accurate at identifying low health literacy than other questions tested, more so even than questions based on demographic characteristics. It is imperative that health care providers understand the meaning consumers place on health and wellness, rather than assuming that the dominant Western medical model is shared. Jargon and complex language can also have the effect of making consumers feel ashamed or inadequate (23). Currently, health care practice and education fall short of equipping providers and consumers with the abilities to effectively communicate with each other.
As with the development and refinement of other skills, building one’s awareness, searching for opportunities to put strategies into practice and asking for feedback are key first steps to building on competence in the area. Implementation of the National Quality Strategy involves identifying and prioritizing quality improvement efforts, sharing lessons learned, and measuring the collective success of Federal, State, and private sector health care stakeholders across the country. The 2012 report also identified three strategic opportunities for improvement, which cut across all six priority areas. These alignment efforts include the work of the Measures Application Partnership, composed of over 60 public- and private-sector organizations, and the Buying Value initiative, a group of 19 private health care purchasers and purchasers' representatives. This report highlights communities, health systems, and organizations that have shown dramatic improvement in each priority area.
Provider payments are increasingly contingent upon demonstrating progress in meeting established performance thresholds. This work immediately inspired action from public and private payers across the health care sector. As of February 2013, the Buying Value purchasers reached agreement with leading health plans on an initial core set of ambulatory care measures for use by health plans and private purchasers. Alignment of private- and public-sector quality measures is critical to lowering the burden of reporting on providers and measuring progress toward achieving better health outcomes, quality care, and lower costs.
CMS is pursuing opportunities to align reporting requirements in 2013 for eligible professionals practicing in groups. As a result, hospital IQR measure data can also be used to determine if the hospital has met its Hospital Value-Based Purchasing measure data reporting requirements.
The goal is to reduce the reporting burden for HRSA grantees, including community health centers and health services organizations, by developing a common reporting platform to more easily report quality measures data. Guided by the six priority areas of the National Quality Strategy, the Measurement Policy Council began by reaching consensus on measures for hypertension control, smoking cessation, hospital-acquired conditions (HAC), care coordination, patient experience of care, and depression screening and remission (see Appendix B).
The 2012 progress report on the National Quality Strategy added national tracking measures in each of the six priority areas to provide a national, all-payer lens through which to understand our national progress. These examples of rapid improvement and achievement of excellence present a preview of the future. The additional targets, appearing for the first time this year, were developed through a consensus process with public- and private-sector content experts using predictive modeling based on past performance of major data sources. High-quality care means appropriate care transitions, so that patients who leave the hospital do not have to be readmitted. VHA's success is built upon its collaboration with hospitals, which view VHA as a trusted advisor, and upon championing the use of qualitative tools and approaches to help hospitals improve safety and quality. Improving health care quality includes improving the experience of care, from ease of getting appointments to clear communication about care plan options.
Over 80 percent of patients who used the tools thought they were very helpful, and the tools also had a significant impact on care choices, including a 50 percent reduction in the number of elective hip replacement surgeries over the 9-month pilot compared with a matched case control group from a previous year. While the rate for patient-centered medical homes (below) fell slightly, we believe that with the burgeoning number of public- and private-sector-sponsored patient-centered medical homes across the Nation, the measure will show improvement over time as the data reflects current reality. The Prevention and Public Health Fund, created by the Affordable Care Act, helps States and communities expand and sustain the necessary infrastructure to prevent disease, detect it early, and manage conditions before they become severe. Additionally, local communities are proving that progress is possible through concerted effort, even on seemingly intractable problems.
Hospital-acquired infections, avoidable readmissions, and uncoordinated, duplicative care endanger patient safety and increase health care costs. Examples of the breadth and depth of activity within each of the strategic opportunities are highlighted below.
The strategy will define specific actions for payers, providers, and vendors, to improve quality using health IT. The first seven organizations from across the country have already been selected, and they include primarily regional nonprofit organizations interested in working with their local health care community to improve quality.33 Participating entities are required to combine these Medicare data with claims data from other sources to produce reports on provider performance that will be available to the general public. Department of Veterans Affairs in collaboration with CMS, the Department of Defense, and the Markle Foundation's Consumer Engagement Workgroup—helps inform and empower patients and their families in their health care decisionmaking.
The Federal Government intends to take a leadership role in developing best practices for monitoring and evaluation, which will be examined in subsequent iterations of this report. The Department's enthusiastic engagement with private payers, through the Measures Application Partnership and the Buying Value initiative, will continue to drive this work.
These measures have been selected in concert with the Measures Application Partnership, and the majority will be used in relevant programs across HHS agencies.
He is Professor Emeritus of Social Epidemiology at the University of Nottingham Medical School, Honorary Professor at UCL and a Visiting Professor at the University of York. It works with the government, scientific bodies, and the voluntary sector to open up debate on issues of importance to Scotland and its global neighbours.
It was during this 3-year tour that he led the operation to eradicate Foot and Mouth Disease from Scotland.As Commandant, he set up and commanded the School of Infantry, based in Catterick, North Yorkshire, for 4 years 2002-2005. In 1994 Phil moved to become a Senior Lecturer in Public Health at the University of Glasgow and was promoted to Professor in 1999. From 2001 -2006 she was the Director of the Graduate School for Arts and Humanities at Glasgow, with responsibility for 600 postgraduate students. 2004) with Manuela Guilherme and Tourism and Intercultural Exchange (2005) with Gavin Jack and most recently Learning the Arts of Linguistic Survival: Tourism, Languaging, Life (2007).
As research and best practice initiatives continue to grow, the need for researchers to effectively communicate with these groups is also important. For those working in health care and the sciences, an awareness of how best to enable effective communication presents important opportunities for the future. Consumers must also make decisions about different types of preventive care such as vaccinations and visits to the doctor. The issue is compounded by shorter lengths of stay and increasing incidence of chronic disease and multiple disorders requiring consumers to manage their own care at home, often with minimal support from health care providers. Canadians with the lowest health-literacy skills were found to be more than 2.5 times likely to be in fair or poor health and to be receiving income support, than those with higher skill levels (6). Forty-two percent of adult Canadians aged 16 to 65 scored at the two lowest levels of literacy (9). Not surprisingly, educational resources also often fall short of reaching people from cultural minorities (11); for example, information on diet and nutrition is often reflective of a Western diet and does not include staples from other cultures, such as tortillas. Without a shared understanding of health, agreeing on behaviors, such as limiting historically and culturally traditional dietary staples that are proving detrimental to an effective course of care can be particularly challenging.

Among Canadians, the most popular sources are family physicians (73%) and other health care professionals (69%) (13).
In practice, health care professionals may not know how to address the challenges of effectively communicating with consumers. For example, ineffective communication between providers has been linked to issues of patient safety, medical error (18), low patient satisfaction and complaints by patients and caregivers (5). These challenges are then exacerbated when providers make assumptions about other professionals’ comprehension, meanings they attribute to situations, values, beliefs, behaviors, etc. Interprofessional education occurs when learners from two or more professions learn about, from and with each other, to enable effective collaboration and improve health outcomes (20). For example, obtaining informed consent and designing research participant materials, communicating with the media and potential donors and speaking with individuals in other fields are areas where improved communication may be required. Those communicating between different professions can also benefit from using these strategies.
In addition, they can contribute to the feelings of shame and embarrassment associated with low literacy and health literacy. Based on the comfort level identified, marginal health literacy and functional literacy can be predicted.
Taking the time to ask open-ended questions can reveal the underlying beliefs and assumptions that a consumer holds, which will allow the communicator to target information and education accordingly. Awareness of one’s own language enables one to recognize that others may not share the same understanding of a key concept or word.
Health care professionals and researchers have an opportunity to improve practice by improving communication efforts with consumers and with each other.
Patient understanding and use of oral contraceptive pills in a southern public health family planning clinic. Perceptions of health literacy: Results of a questionnaire for practitioners, policy-makers and researchers. Interprofessional Communication and Medical Error: A Reframing of Research Questions and Approaches. The Single Item Literacy Screener: Evaluation of a brief instrument to identify limited reading ability.
Culture, illness, and care: Clinical lessons from anthropologic and cross-cultural research.
This second annual report provides updates on public and private payers' collaborative efforts to align quality measures, progress against national tracking measures (where possible) and establishment of aspirational targets (as needed), private-sector successes in each of the six priority areas, and progress on each of the three strategic opportunities.
These organizations are working together and making progress toward developing common performance measures for value purchasing among public and private payers. Their success demonstrates the potential impact of implementation of the National Quality Strategy. The Buying Value Common Measures list now includes 35 measures; 20 of these measures are part of Stage 2 Meaningful Use in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. The ongoing, iterative alignment between HHS and initiatives such as Buying Value are important steps forward in achieving consensus among private and public payers on quality measurement.
In 2012, CMS launched the process for using electronic health records to directly report the quality data required by other hospital programs, and allow hospitals using certified EHR technology to use the same data (and often in the same format) to report on quality measurement and deliver clinical care.
The council, composed of 11 HHS operating divisions, also agreed on processes for adoption of consensus measures across programs.
These targets were established with the recognition of the slow rate in which progress can be shown across nationally representative data in combination with the need for the targets to have face validity with the general public. To improve this experience for patients and their caregivers, Mount Sinai opened a geriatric Emergency Department (ED) that is quieter, has more space, and allows family members and caregivers to be with patients. Based on these and similar favorable results from other pilots, Kaiser Permanente is expanding the use of these decision aids to all of its medical centers in Southern California, Colorado, and the Northwest. The team members are physically co-located to encourage communication and, when patients call, nurses decide whether to schedule a same-day appointment with a physician or health care provider or offer counseling by phone. Improving the quality of American health care demands an intense focus on preventing and treating cardiovascular disease. The National Quality Strategy focuses attention on keeping care affordable as efforts to innovate and improve health and health care delivery continue. Medicare spending per beneficiary grew just 0.4 percent per capita in fiscal year 2012, continuing the pattern of very low growth in 2010 and 2011.
It serves about one-third of all 3.4 million CareFirst members in Maryland, Washington, DC, and northern Virginia.
The Blue Button capability allows Veterans to securely download their personal health information from their My HealtheVet account, and self-enter their personal health indicators, emergency contact information, test results, and family health history. More than half of eligible providers have qualified for and received incentive payments for demonstrating meaningful use of EHRs, and nearly 80 percent of eligible hospitals have done so. Future iterations of this report will describe these ongoing efforts and will also reflect the breadth of participation in quality reporting and improvement efforts. This body of wisdom will grow as we evaluate the new models of care being tested across the Nation.
Richard co-wrote The Spirit Level with Kate Pickett which won the 2011 Political Studies Association Publication of the Year Award and the 2010 Bristol Festival of Ideas Prize. The group organised large conferences and events to stimulate creative parish mission strategies. He is a lay member of the board of the Chartered Insurance Institute and of the European Financial Planning Association. The Council is quite intentional in its focus on social justice, and uses those lenses to frame its work. In 2006 he was appointed Deputy Commanding General of the Multi-National Security Transition Command - Iraq (MNSTC-I) based in Baghdad.
In 2006 she moved to establish the Graduate School in the Faculty of Education, still at Glasgow, was now Associate Dean (Postgraduate) from 2008-2010. They celebrate and recognise the role and its importance while encouraging Assistants to take control of their personal development, and drive their own career agendas.
This article will explore some of the unique characteristics of communication both with consumers and between health care professionals.
They must make sense of health and science reports they read in the media (e.g., Bisphenol A causing cancer? The need for health care professionals and researchers to effectively communicate with consumers will only grow in its urgency. Colors, as another example, can also play a role on how people of different cultures respond to information if it conveys certain meaning to them.
While Canadians report that they are able to find relevant information, more than half report finding contradictory information from different sources and one-third report that people don’t have time to answer their questions (14). For example, a survey of nearly 700 professionals and policymakers found low levels of awareness of strategies to lower literacy demands and promote health literacy skills (17).
Further, consideration of how to support student learning between health care professionals and potentially biomedical students is starting to be addressed (21). The health care system and science communication overall can be made more accessible to individuals using several communication strategies. A question that focuses on comfort level with medical forms also removes the focus from the patient’s literacy level.
However, many continue to practice under the assumption these trends do not apply to their consumer groups, or that they are effective communicators despite the absence of specific training, effort and feedback. A survey of interprofessional education in communication skills in health care programmes in the UK. Role understanding and effective communication as core competencies for collaborative practice.
Stereotyping at the undergraduate level revealed during interprofessional learning between future doctors and biomedical scientists. Additionally, multiple Federal agencies are making significant strides in reducing the reporting burden for providers by aligning performance measures across programs and reducing the number of measures where possible. The National Quality Strategy helps foster alignment of performance measures across the Federal Government, the private sector, States, and even individual health systems and providers. Furthermore, many hospital programs are aligning to focus on smaller sets of measures that maximize improvement and better outcomes for patients.
The section below includes updates to these baselines where new national data are available. Over time, we do expect to see progress in National Quality Strategy implementation reflected in improved results in these tracking measures. VHA then works with hospitals over a 10- to 14-week period to redesign and test new clinical practices that more closely align with the leading institutions.
Understanding the importance of a simple person-to-person conversation, trained volunteers armed with reading glasses, hearing aids, crossword puzzles, and magazines sit with seniors to help them get their bearings and feel comfortable. Now thousands of patients will be supported in making the decisions that are consistent with their lifestyles and values. As a result of its team-based care coordination, the Foundation has seen a decrease in emergency room visits by 5 percent, hospital admissions by 53 percent, specialty care visits by 65 percent, and visits to primary care doctors by 20 percent.11 The Foundation also uses its EHR system to facilitate care coordination and keep medical records safe and private, ensure prescription safety, and provide alerts and reminders about health screenings and immunizations. The Million Hearts Initiative is a public-private partnership between HHS and 65 partners, led by the Centers for Disease Control and Prevention, with the goal of preventing 1 million heart attacks and strokes over the next 5 years. The Affordable Care Act also makes it easier for patients with private insurance or Medicare to afford necessary preventive services, like mammograms and wellness exams, by prohibiting insurers from charging co-pays for these important services.
The strategy provides a national call to align clinical best practices and outcomes with financial incentives through new health care delivery models, such as ACOs, patient-centered medical homes, and bundled payment arrangements. The medical home program links insurance payments to primary care providers to the quality of care they deliver. Medicare beneficiaries can use Blue Button to download copies of their personal health information from their account. RECs have been successful at getting medical practices to change the way they use health IT to improve quality. He is currently a member of the World Mission Future Strategy Group.He has explored the use of the arts in worship and Christian apologetics. He serves as a public interest member of the Investigations Committee of the Institute of Chartered Accountants of Scotland.From 1988-2007 he was chief executive of the Chartered Institute of Bankers in Scotland and served for a time as President of the European Bank Training Network. This command had responsibility for training and equipping the new Iraqi Army and Police Force.He was appointed as the Colonel of the Regiment for The Highlanders (Seaforth, Gordons and Camerons) in 2002. She has published widely in the field of modern languages, tourism and intercultural studies and European anthropology as well as in the field of Higher Education Studies.
These challenges are further exacerbated by health care professionals who may lack the ability to communicate effectively across professions. Vitamin D preventing multiple sclerosis?) and make decisions about whether to integrate new practices into their own lives.
In the United States, the estimated cost of low health literacy is between $106 and $236 billion USD (8). However, even those with average literacy may face difficulties when encountering unfamiliar types of material or texts (2), or information requiring problem-solving or interpretation, such as instructions on missed birth control pills (10). For instance, in many western cultures, red is used as a symbol for caution or stopping, as in stop signs and traffic signals.
The use of online information is also growing significantly; 61% of adults now look for health information online (15).
Thus, using a single question screening may be a time-efficient way to determine which patients need additional probing or information.
For some professions, it may mean moving from the bed to the wheelchair; however for others it may refer to the process of referral from one hospital to another.
When all payers use the same measures, stakeholders have consistent information to gauge performance and outcomes, and providers have a lower reporting burden. While this work resides within HHS, the MPC used criteria established by the Measures Application Partnership, a public-private partnership convened by the National Quality Forum.
The data sources for the key measures provide nationally representative snapshots, but there is a lag between when the data snapshot is taken and when the information is available to report; accordingly, the data collection and reporting is slow to show progress. Since 2011, Dignity Health has dramatically reduced rates of hospital-acquired infections across its 36 hospitals in 3 states, achieving a 70 percent decline in central-line associated bloodstream infections (CLABSI), a 53 percent decline in ventilator-associated pneumonia (VAP), a 52 percent decline in surgical site infections (SSI), and a 24 percent reduction in catheter-associated urinary tract infections (CAUTI). The initiative is focusing on aspirin use, blood pressure and cholesterol screenings, clinical decision and caregiver support, and smoking cessation to achieve this goal. But even as these changes go into effect nationally, local communities remain leaders in public health promotion and achievement.
In June 2013, CareFirst reported that the program reduced costs and improved the quality of care even more in its second year than in its first, citing cost savings of $98 million for the medical home program in 2012, compared with $38 million the year before. In addition to Federal agencies, private-sector partners like UnitedHealth Group, Aetna, and Kaiser Permanente are adopting Blue Button.
They are helping providers meet challenges to achieve meaningful use and are leveraging those accomplishments to support quality improvement and other health care transformation goals. He was among the first Christian musicians to perform at the now prestigious Greenbelt Festival when it started in 1973. Prior to that he was a university lecturer for 13 years and a bank clerk in Glasgow for 3 years.He has served as a member of the board of the Scottish Qualifications Authority and of the Quality Assurance Agency for Higher Education. In 2012 she received an OBE for Services to Education and Intercultural and Interreligious Relations in the Queen’s Birthday Honours.
She co-edits the journal and book series Tourism and Cultural Change and the book series Languages, Intercultural Communication and Education and is editor of the journal Arts and Humanities in Higher Education. Effective transfer of knowledge also needs to occur between providers themselves in order to enable best outcomes for consumers. There is little data on the estimated cost in Canada, but the astronomical cost faced in the US is an indicator of the potential burden that low health literacy can place on the Canadian system. It is therefore important to use best practice communication strategies to address these challenges. In some Eastern cultures, red is a sign of prosperity and happiness, often worn by brides in weddings. Unfortunately, even online information may not be meeting the needs of Canadians with low literacy, as studies have demonstrated that consumer health information is often written at high reading levels and may contain medical jargon (16).
Recognizing one’s own use of jargon, requesting clarification from colleagues when unclear terminology is used and using jargon-free language where possible are important first steps in enabling effective communication. We expect to show progress on the national quantitative data over time, but for this report, we're highlighting select programs across the Nation that demonstrate progress in each of the priority areas.
Together these four harms represent over 80 percent of all health care-associated infections nationwide.
Most of the savings came from reduced hospital admissions, less use of emergency rooms, and lower spending on drugs.
He has appeared on radio and television as a Christian broadcaster and is a regular blogger. From 1999 - 2004 She was Chair of the International Association for Languages and Intercultural Communication (IALIC).
Those managing their own care need effective health information and education to know how to do so (4). In a health care context, red used as a warning symbol may be overlooked by those who are not accustomed to the Western symbolism of the color. Through engagement with the Partnership for Patients, these systems and other high performers now share their best practices, such as the use of clinical decision support and quality measure alignment, with 3,700 hospitals nationwide. As part of the ministry at Bo'ness a not for profit media company has been established, along with a number of community entrepreneurial social outreach programmes. She is a senior policy advisor to the British Council and was an advisor to the World Council of Churches’ International Ecumenical Peace Convocation from 2007-2011. For example, managing diet, checking blood pressure and managing insulin may be among health related tasks needing to be performed daily within the home setting.
Currently, the charity has HRH The Princess Royal as its patron and is now working not only in Amazonia where it has developed a free health service for over 100,000 people, but also in Tanzania where it hopes to place a third ship on Lake Victoria in 2013. His Bo'ness congregation at present are developing the World Without Walls Programme linking parishes in Scotland with overseas programmes.Until recently Albert wrote a weekly column in the local newspaper. His first publication appeared in the Scottish Church History Society Records, writing about the life of Rev James Barr MP, who played an enormous role in the politics of church and society in the early 20th century.
He has also written about the theology of Entertainment, and has had two books of prayers published.
He has recorded five albums of songs co-written by his long standing songwriting partner Iain Jamieson.Mr Bogle is married to Martha who retires this year after a distinguished career in education as an advocate for children with supported learning needs.

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