This review is part of a series of reports, Closing the Quality Gap: Revisiting the State of the Science, commissioned by the Agency for Healthcare Research and Quality (AHRQ). The series provides a critical analysis of existing literature on quality improvement strategies and issues for topics identified by the 2003 Institute of Medicine report Priority Areas for National Action: Transforming Health Care Quality.1 As part of its charge to continuously assess progress toward quality and to update the list of priority areas, AHRQ identified people with disabilities as a priority population. Health care for people with disabilities can present special challenges. For example, medical problems can be exacerbated or complicated by the presence of other medical, psychological, economic, and social problems. Likewise, the management of medical problems can be complicated by disability. Thus, optimal care requires coordination of services from various sectors to maximize the function and quality of life of a person with a disability. Since the care outcomes of function, quality of life, and community integration are interdependent, service coordination may need to span the spectrums of both care and support services (e.g., medical care and schools or social agencies). Coordination of care, with attention to the intersection of medical and social services, is congruent with recent policy attention on integrated care and medical homes. This review examines how health care outcomes have been assessed for people with disabilities. Our report seeks to improve shared understanding among a broad audience of researchers, clinicians, and policymakers with varied exposure to disability outcomes or quality improvement research. We begin by discussing outcome measurement issues and exploring conceptual frameworks for thinking about measuring outcomes for research and quality improvement efforts. We examine the diverse perspectives that researchers grounded in different fields bring to bear on what and how to measure. As with all frameworks that deal with complex concepts, the categories, paradigms, or classes we present are at best "ideal types" rather than simple designations with clean boundaries. Our Key Questions (KQs) focus on the quality assessment component of quality improvement. Using the levels-of-analysis framework, we examined outcome measures for medical care and care coordination for people with disabilities, with an emphasis on outcome measures at the level of the individual rather than the population. Key questions include: KQ1. How are outcomes assessed for people with disabilities living in the community in terms of basic medical service needs? KQ1a. What general population outcomes have been validated on and/or adjusted to accommodate disabled populations? KQ1b. What types of modifiers or case-mix adjusters have been used with the general population outcomes to recognize the special circumstances of people with disabilities? KQ1c. What are key parameters for measuring processes related to basic service care access for people with disabilities? KQ2. What measures have been used to assess effectiveness of care for people with disabilities living in the community in the context of coordination among health providers? KQ3. What measures have been used to assess effectiveness of care for people with disabilities living in the community in the context of coordination between community organizations and health providers?

This volume, developed by the Observatory together with OECD, provides an overall conceptual framework for understanding and applying strategies aimed at improving quality of care. Crucially, it summarizes available evidence on different quality strategies and provides recommendations for their implementation. This book is intended to help policy-makers to understand concepts of quality and to support them to evaluate single strategies and combinations of strategies.

A new release in the Quality Chasm Series, Priority Areas for National Action recommends a set of 20 priority areas that the U.S. Department of Health and Human Services and other groups in the public and private sectors should focus on to improve the quality of health care delivered to all Americans. The priority areas selected represent the entire spectrum of health care from preventive care to end of life care. They also touch on all age groups, health care settings and health care providers. Collective action in these areas could help transform the entire health care system. In addition, the report identifies criteria and delineates a process that DHHS may adopt to determine future priority areas.

This User’s Guide is intended to support the design, implementation, analysis, interpretation, and quality evaluation of registries created to increase understanding of patient outcomes. For the purposes of this guide, a patient registry is an organized system that uses observational study methods to collect uniform data (clinical and other) to evaluate specified outcomes for a population defined by a particular disease, condition, or exposure, and that serves one or more predetermined scientific, clinical, or policy purposes. A registry database is a file (or files) derived from the registry. Although registries can serve many purposes, this guide focuses on registries created for one or more of the following purposes: to describe the natural history of disease, to determine clinical effectiveness or cost-effectiveness of health care products and services, to measure or monitor safety and harm, and/or to measure quality of care. Registries are classified according to how their populations are defined. For example, product registries include patients who have been exposed to biopharmaceutical products or medical devices. Health services registries consist of patients who have had a common procedure, clinical encounter, or hospitalization. Disease or condition registries are defined by patients having the same diagnosis, such as cystic fibrosis or heart failure. The User’s Guide was created by researchers affiliated with AHRQ’s Effective Health Care Program, particularly those who participated in AHRQ’s DEcIDE (Developing Evidence to Inform Decisions About Effectiveness) program. Chapters were subject to multiple internal and external independent reviews.

"Nurses play a vital role in improving the safety and quality of patient car -- not only in the hospital or ambulatory treatment facility, but also of community-based care and the care performed by family members. Nurses need know what proven techniques and interventions they can use to enhance patient outcomes. To address this need, the Agency for Healthcare Research and Quality (AHRQ), with additional funding from the Robert Wood Johnson Foundation, has prepared this comprehensive, 1,400-page, handbook for nurses on patient safety and quality -- Patient Safety and Quality: An Evidence-Based Handbook for Nurses. (AHRQ Publication No. 08-0043)." - online AHRQ blurb, http://www.ahrq.gov/qual/nurseshdbk/