A new Health Policy Brief from Health Affairs and the Robert Wood Johnson Foundation examines the ongoing need to improve the quality and safety of health care provided in the United States. Despite some progress toward goals set a decade ago following two landmark Institute of Medicine studies, the nation faces considerable challenges in making health care safe; effective; efficient; patient-centered; delivered on a timely basis; and devoid of ethnic, racial, and other disparities.

This policy brief explains how health care quality is commonly defined; examines the issues around measuring it; highlights some recent findings on quality improvement efforts, and discusses the key challenges still to be overcome. The policy brief is a companion to Health Affairs’ April issue, “Still Crossing The Quality Chasm.”

The brief includes the following:

  • Despite improvements in recent years, health care in the United States is not as safe as it could be.  A study published in Health Affairs suggests that during the care of one in three patients admitted to hospitals, a medical error occurs.  And about 40 surgeries are performed each week on the wrong patient, or the wrong site of the patient’s body, according to the Joint Commission, the organization that accredits health care organizations.
  • Efforts have been made over the past decade to set standards, create checklists, and adopt other techniques to reduce medical errors and improve the quality of care being delivered.  Many have paid off—for example, lower rates of bacterial and fungal infections that get into the bloodstream through catheters, ventilators, or other equipment used in hospitals and health care settings.
  • Provisions in the Affordable Care Act are aimed at jumpstarting quality improvement efforts. For instance, starting in 2013, hospitals where readmission rates for patients with heart failure and other ailments exceed a particular target will be financially penalized under Medicare; conversely, those who perform better than expected will receive financial incentives.
  • More needs to be done. Patients need to play a greater role in evaluating the pros and cons to determine the optimal course of their own health care.  As Floyd Fowler and colleagues write in the current issue of Health Affairs, “High-quality medical decisions require that patients be fully informed and involved in the decision-making process.”  And hospitals and other health care organizations need to become “high reliability” organizations, with performance and safety standards set as high as other industries, such as aviation.

About Health Policy Briefs:

Health Policy Briefs are aimed at policy makers, congressional staffers, and others who need short, jargon-free explanations of health policy basics. The briefs include competing arguments on policy proposals from various sides and the relevant research supporting each perspective.

Previous policy briefs have addressed:

Unreasonable Rate Increases:  New rules outline procedures for reviewing potentially “unreasonable” health insurance rate increases.

Employers and Health Care Reform: The Affordable Care Act will assess taxes on companies that fail to offer their employees health coverage.

Congress and the Affordable Care Act: Members opposed to the health reform law have pledged to repeal it, replace it, or block its implementation.

Repealing the 1099 requirement: Regardless of the fate of the rest of the Affordable Care Act, a tax-reporting requirement for businesses, designed to raise revenues to finance health reform, is likely to be repealed.

Medicaid and CHIP enrollment.  The federal government is seeking to identify and enroll approximately 5 million uninsured children in the United States who are eligible for Medicaid or the Children’s Health Insurance Program (CHIP).

Small business tax credits: The Affordable Care Act offers incentives so that more small businesses will help provide their employees with health insurance.

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Health Policy Briefs offer more context than fact sheets but are more easily read than many other backgrounder papers. The information is objective and reviewed by Health Affairs authors and other specialists with years of expertise in health policy.

You can sign up for e-mail alerts from Health Affairs about upcoming briefs. The briefs are also available from the Robert Wood Johnson Foundation’s website. Please feel free to forward the briefs to any of your colleagues who are tracking health issues. And after you’ve taken a look, we welcome your feedback at: hpbrief@healthaffairs.org