This report is one of five volumes providing detailed information on the QA Tools, RAND's comprehensive, clinically based system for assessing quality of care for children and adults. The QA Tools indicators encompass screening, diagnosis, treatment, and follow-up in 46 clinical areas and cover a variety of modes of providing care, including history, physical examination, laboratory study, medication, and other interventions and contacts. Development of each indicator was based on the ratings of a panel of experts in the relevant fields and on a focused review of the scientific literature, which is clearly documented for each clinical condition. This volume focuses on indicators for care of oncologic conditions and HIV. Each chapter summarizes the results of the literature review for a particular condition, provides RAND staff's recommended indicators based on that review, and notes the level of scientific evidence supporting each indicator along with the relevant citations. In addition, this work details the process by which the expert panel evaluated the indicators and the final disposition of each indicator. Clinical conditions covered in this volume are: Breast cancer, cervical cancer, colorectal cancer, HIV, lung cancer, prostate cancer, skin cancer, cancer pain and palliation. Other RAND Health titles on the QA Tools system focus on indicators for care of children and adolescents, general medical conditions, cardiopulmonary conditions, and women.

Developing and implementing a valid system of-quality assessment is essential for effective functioning of the health care system. Although a number of groups have produced quality assessment tools, these tools typically suffer from a variety of limitations. Information is obtained on only a few dimensions of quality, the tools rely exclusively on administrative data, they examine quality only for users of services rather than the population, or they fail to provide a scientific basis for the quality indicators. Under funding from public and private sponsors, including the Health Care Financing Administration (HCFA), the Agency for Healthcare Research and Quality (AHRQ), the California HealthCare Foundation, and the Robert Wood Johnson Foundation (RWJ), RAND has developed and tested a comprehensive, clinically based system for assessing quality of care for children and adults. We call this system QA Tools. In this introduction, we discuss how the clinical areas were selected, how the indicators were chosen, and what is included in the overall system. We then describe in detail how we developed the indicators for children and adolescents.

This report is one of five volumes providing detailed information on the QA Tools, RAND's comprehensive, clinically based system for assessing quality of care for children and adults. The QA Tools indicators encompass screening, diagnosis, treatment, and follow-up in 46 clinical areas and cover a variety of modes of providing care, including history, physical examination, laboratory study, medication, and other interventions and contacts. Development of each indicator was based on the ratings of a panel of experts in the relevant fields and on a focused review of the scientific literature, which is clearly documented for each clinical condition. This volume focuses on indicators for care of general medical conditions. Each chapter summarizes the results of the literature review for a particular condition, provides RAND staff's recommended indicators based on that review, and notes the level of scientific evidence supporting each indicator along with the relevant citations. In addition, this work details the process by which the expert panel evaluated the indicators and the final disposition of each indicator. Clinical conditions covered in this volume are: Acne, alcohol dependence, allergic rhinitis, benign prostatic hyperplasia, cataracts, cholelithiasis, dementia, depression, diabetes mellitus, hormone replacement therapy, headache, hip fracture, hysterectomy, inguinal hernia, acute low back pain, orthopedic conditions. Other RAND Health titles on the QA Tools system focus on indicators for children and adolescents, oncology and HIV, cardiopulmonary conditions, and women.

This report is one of five volumes providing detailed information on the QA Tools, RAND's comprehensive, clinically based system for assessing quality of care for children and adults. The QA Tools indicators encompass screening, diagnosis, treatment, and follow-up in 46 clinical areas and cover a variety of modes of providing care, including history, physical examination, laboratory study, medication, and other interventions and contacts. Development of each indicator was based on the ratings of a panel of experts in the relevant fields and on a focused review of the scientific literature, which is clearly documented for each clinical condition. This volume focuses on indicators for care of cardiopulmonary conditions. Each chapter summarizes the results of the literature review for a particular condition, provides RAND staff's recommended indicators based on that review, and notes the level of scientific evidence supporting each indicator along with the relevant citations. In addition, this work details the process by which the expert panel evaluated the indicators and the final disposition of each indicator. Clinical conditions covered in this volume are: Asthma, atrial fibrillation, cerebrovascular disease, chronic obstructive pulmonary disease, cigarette counseling, community-acquired pneumonia, coronary artery disease, heart failure, hyperlipidemia, hypertension, upper respiratory infections. Other RAND Health titles on the QA Tools system focus on indicators for general medicine, oncology and HIV, children and adolescents, and women.

A guide to indicators for care of women. Each chapter summarizes the results of the literature review for a particular condition, provides recommended indicators based on that review, and lists the cited studies. Clinical conditions range from acne and asthma to depression and prenatal care.

This report is one of five volumes providing detailed information on the QA Tools, RAND's comprehensive, clinically based system for assessing quality of care for children and adults. The QA Tools indicators encompass screening, diagnosis, treatment, and follow-up in 46 clinical areas and cover a variety of modes of providing care, including history, physical examination, laboratory study, medication, and other interventions and contacts. Development of each indicator was based on the ratings of a panel of experts in the relevant fields and on a focused review of the scientific literature, which is clearly documented for each clinical condition. This volume focuses on indicators for care of children and adolescents. Each chapter summarizes the results of the literature review for a particular condition, provides RAND staff's recommended indicators based on that review, and lists the cited studies. In addition, this work details the process by which the expert panel evaluated the indicators and the final disposition of each indicator. Clinical conditions covered in this volume are: Acne, preventive services, allergic rhinitis, asthma, attention deficit disorder, cesarean delivery, depression, developmental screening, diabetes mellitus, acute diarrheal disease, family planning/contraception, fever without source of infection in children under 3 years of age, headache, immunizations, otitis media, acute otitis media, prenatal care, sickle cell screening, tuberculosis, upper respiratory infections, urinary tract infections, vaginitis and sexually transmitted diseases, well child care. Other RAND Health titles on the QA Tools system focus on indicators for general medicine, oncology and HIV, cardiopulmonary conditions, and women.

How good is the quality of health care in the United States? Is quality improving? Or is it suffering? While the average person on the street can follow the state of the economy with economic indicators, we do not have a tool that allows us to track trends in health care quality. Beginning in 2003, the Agency for Healthcare Research and Quality (AHRQ) will produce an annual report on the national trends in the quality of health care delivery in the United States. AHRQ commissioned the Institute of Medicine (IOM) to help develop a vision for this report that will allow national and state policy makers, providers, consumers, and the public at large to track trends in health care quality. Envisioning the National Health Care Quality Report offers a framework for health care quality, specific examples of the types of measures that should be included in the report, suggestions on the criteria for selecting measures, as well as advice on reaching the intended audiences. Its recommendations could help the national health care quality report to become a mainstay of our nation's effort to improve health care.