Skip to main content
Log in

Brief history of quality movement in US healthcare

  • Health Policy (AD Sharan, Section Editor)
  • Published:
Current Reviews in Musculoskeletal Medicine Aims and scope Submit manuscript

Abstract

The current healthcare quality improvement infrastructure is a product of a century long experience of cumulative efforts. It began with an acknowledgement of the role of quality in healthcare, and gradually evolved to encompass the prioritization of quality improvement and the development of systems to monitor, quantify, and incentivize quality improvement in healthcare. We review the origins and the evolution of the US healthcare quality movement, identify existing initiatives specific to musculoskeletal care, outline significant challenges and opportunities, and propose recommendations for the future. Elements noted to be associated with successful healthcare quality improvement efforts include the presence of physician leadership, infrastructural support, and prioritization of healthcare quality within the culture of the organization. Issues that will require continued work include the development of a valid and reliable evidence base, accurate and replicable performance measurement and data collection methods, and development of a standard set of specialty specific performance metrics, with accurate provider attribution, risk adjustment and reporting mechanisms.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Colton D. Quality improvement in health care. Conceptual and historical foundations. Eval Health Prof. 2000;23:7–42.

    Article  CAS  PubMed  Google Scholar 

  2. Donabedian A. The evaluation of medical care programs. Bull N Y Acad Med. 1968;44:117–24.

    CAS  PubMed  Google Scholar 

  3. Williamson JW. Evaluating quality of patient care. A strategy relating outcome and process assessment. JAMA. 1971;218:564–9.

    Article  CAS  PubMed  Google Scholar 

  4. Brook RH, Appel FA. Quality-of-care assessment: choosing a method for peer review. N Engl J Med. 1973;288:1323–9.

    Article  CAS  PubMed  Google Scholar 

  5. Brook RH, Stevenson Jr RL. Effectiveness of patient care in an emergency room. N Eng J Med. 1970;283:904–7.

    Article  CAS  Google Scholar 

  6. Brook RH. The end of the quality improvement movement: long live improving value. JAMA. 2010;304:1831–2.

    Article  CAS  PubMed  Google Scholar 

  7. McIntyre D, Rogers L, Heier E. Overview, history, and objectives of performance measurement. Health Care Financ Rev. 2001;22:7–21.

    Google Scholar 

  8. Loeb JM. The current state of performance measurement in health care. Int J Qual Health Care. 2004;16 Suppl 1:i5–9.

    Article  PubMed  Google Scholar 

  9. Institute of Medicine. Crossing the quality chasm: a new health system for the 21st Century Committee on Quality of Health Care in America, ed. Washington, DC: N.A. Press; 2001.

  10. Center for Medicare and Medicaid Services. Title XVIII of the Social Security Act, in Title 42. Center for Medicare and Medicaid Services, Editor; 1965.

  11. Luce JM, Bindman AB, Lee PR. A brief history of health care quality assessment and improvement in the United States. West J Med. 1994;160:263–8.

    CAS  PubMed  Google Scholar 

  12. Bohmer RMJ. Designing care: aligning the nature and management of health care. Boston: Harvard Business Press; 2009.

    Google Scholar 

  13. • Chassin MR, Loeb JM. The ongoing quality improvement journey: next stop, high reliability. Health Aff. 2011;30:559–68. Discussion of 3 critical changes that health care must make to become a high reliability industry: leadership and the prioritization of high reliability (consistent excellence over prolonged period); the creation of a culture of safety within an organization; the use of proven quality methods to improve processes and avoid common, critical mistakes.

    Article  Google Scholar 

  14. Leavitt MO, S.o.H.a.H.S. Report to congress on the evaluation of the quality improvement organization (qio) program for medicare beneficiaries for fiscal year 2006. Centers for Medicare & Medicaid Services; 2009.

  15. The Joint Commission. The Joint Commission history. Available at: http://www.jointcommission.org/assets/1/6/Joint_Commission_History_2012.pdf. Accessed June ,1 2012.

  16. Donabedian A. Evaluating the quality of medical care. Milbank Mem Fund Q. 1966;44(Suppl):166–206.

    Article  PubMed  Google Scholar 

  17. • Auerbach A. Healthcare quality measurement in orthopaedic surgery: current state of the art. Clin Orthop Relat Res. 2009;467:2542–7. Description of quality improvement efforts related to arthroplasty that are based on measurement and reporting of data describing structural factors, care processes, and clinical outcomes. Structural (ie, surgical volume) and process measures (ie, SCIP measures) have been applied with varying grades of success. Outcome measures (ie, NSQIP measures) though more costly, reported to improve care more broadly. Care will only be improved if improved outcomes are delivered at lower or equivalent costs.

    Article  PubMed  Google Scholar 

  18. The Institute of Medicine of the National Academies. The Institute of Medicine Study Process. Available at: http://nationalacademies.org/studyprocess/index.html. Accessed June 1; 2012.

  19. AHRQ. Working for Quality. Available at :http://www.ahrq.gov/workingforquality/nqs/nqs2012annlrpt.pdf. Accessed June 1; 2012.

  20. Duke University Medical Center. What is quality improvement? Available at: http://patientsafetyed.duhs.duke.edu/module_a/introduction/stakeholders.html. Accessed April 5; 2012.

  21. Steinwachs DM, Hughes RG. Health services research: scope and significance; 2008.

  22. Center for Medicare and Medicaid Services. HCAHPS Fact Sheet (CAHPS Hospital Survey). Available at: http://www.hcahpsonline.org/files/HCAHPS Fact Sheet 2010.pdf. Accessed June 7; 2012.

  23. Sennett C. An introduction to the National Committee for Quality Assurance. Pediatr Ann. 1998;27:210–4.

    CAS  PubMed  Google Scholar 

  24. • Fisher E, Goodman D, Skinner J, Bronner K. Health care spending, quality, and outcomes. More isn’t always better. Dartmouth Atlas Healthcare Reports; 2009. Topic brief that examines relationship between regional differences in spending and the quality of care. Identifies 3 underlying causes of regional variation: lack of accountability for overall quality and costs of care; inadequate information on risks and benefits of common treatments, and assumption that more medical care equal better medical care; a flawed payment system that rewards more care, regardless of value. Available at: http://www.dartmouthatlas.org/downloads/reports/Spending_Brief_022709.pdf

  25. Berwick DM. A user’s manual for the IOM’s ‘quality chasm’ report. Health Aff. 2002;21:80–90.

    Article  Google Scholar 

  26. Gagel BJ. Health Care Quality Improvement Program: a new approach. Health Care Financ Rev. 1995;16:15–23.

    CAS  PubMed  Google Scholar 

  27. Khuri SF, Daley J, Henderson W, et al. The department of veterans affairs' NSQIP: the first national, validated, outcome-based, risk-adjusted, and peer-controlled program for the measurement and enhancement of the quality of surgical care. National VA Surgical Quality Improvement Program. Ann Surg. 1998;228:491–507.

    Article  CAS  PubMed  Google Scholar 

  28. Khuri SF. The NSQIP: a new frontier in surgery. Surgery. 2005;138:837–43.

    Article  PubMed  Google Scholar 

  29. Fink AS, Campbell Jr DA, Mentzer Jr RM, et al. The National Surgical Quality Improvement Program in non-veterans administration hospitals: initial demonstration of feasibility. Ann Surg. 2002;236:344–53. discussion 353–4.

    Article  PubMed  Google Scholar 

  30. The Institute of Medicine of the National Academies. To err is human: building a safer health system. Washington DC; 1999.

  31. Committee on Quality of Health Care in America, Institute of Medicine. "Front Matter." Crossing the Quality Chasm: A new Health System for the 21st Century. Washington, DC: The National Academies Press, 2001

  32. National Quality Forum (NQF). About NQF. Available at: http://www.qualityforum.org/About_NQF/Mission_and_Vision.aspx. Accessed June 7; 2012.

  33. The National Quality Forum. National quality forum mission and vision. Available at: http://www.qualityforum.org/About_NQF/About_NQF.aspx. Accessed June 7; 2012.

  34. Bratzler DW, Hunt DR. The surgical infection prevention and surgical care improvement projects: national initiatives to improve outcomes for patients having surgery. Clin Infect Dis. 2006;43:322–30.

    Article  PubMed  Google Scholar 

  35. • Rosenberger LH, Politano AD, Sawyer RG. The surgical care improvement project and prevention of postoperative infection, including surgical site infection. Surg Infect. 2011;12:163–8. Review and analysis of the 2006 Surgical Care Improvement Project (SCIP). Initiative developed in response to inconsistent compliance with infection prevention measures. Under SCIP standard process and outcome quality improvement measures were developed to standardize processes in effort to increase compliance. Seven of the SCIP initiatives apply to the peri-operative period. There is strong evidence that implementation of protocols that standardize practices result in reduced risk of surgical infection.

    Article  Google Scholar 

  36. • No Authors Listed. Rule emphasizes quality and cost savings. Hosp Case Manag. 2011;19:148–9. Summary of The Centers for Medicare and Medicaid Services (CMS) 2012 final rule on the Inpatient Prospective Payment System (IPPS). Rule establishes that hospitals will receive a net 1 % increase in reimbursement, also proposes to add a measure of Medicare spending per beneficiary to the Hospital Inpatient Quality Reporting program and the Value Based Purchasing program in effort to reduce costs by rewarding efficient care rather than volume. Finally in an effort to reduce preventable healthcare associated infections HAIs, the rule introduces new quality measures to be implemented in 2014 and 2015

  37. Centers for Medicare and Medicaid Services. Legislative Update. Available at: https://http://www.cms.gov/Regulations-and-Guidance/Legislation/LegislativeUpdate/index.html?redirect=/LegislativeUpdate/. Accessed June 7; 2012.

  38. US Congress. H.R. 6331 (110th): Medicare Improvements for Patients and Providers Act of 2008. Available at: http://www.govtrack.us/congress/bills/110/hr6331. Accessed June 7; 2012.

  39. Department of Health and Human Services. Medicare Program; payment policies under the physician fee schedule, 5-year review of work relative value units, clinical laboratory fee schedule: signature on requisition, and other revisions to Part B for CY 2012, in Federal Register/Vol. 76, No. 228, Centers for Medicare & Medicaid Services; 2011.

  40. Center for Medicare and Medicaid Services. Physician quality reporting system. Available at: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/index.html?redirect=/pqrs. Accessed April; 2012.

  41. Congress, US, The Patient Protection and Affordable Care Act, Washington DC; 2010.

  42. Pearson SD, Bach PB. How medicare could use comparative effectiveness research in deciding on new coverage and reimbursement. Health Affairs. 2010; 29.

  43. US Department of Health and Human Services. Medicaid Program; payment adjustment for provider-preventable conditions including health care-acquired conditions, CFMM Services; 2011.

  44. US Department of Health and Human Services, Annual progress report to Congress: National Strategy for Quality Improvement in Health Care, USDoHaH Services, Washington, DC; 2012.

  45. Department of Health and Human Services and Centers of Medicare & Medicais Services. https://www.federalregister.gov/articles/2011/05/06/2011-10568/medicare-program-hospital-inpatient-value-based-purchasing-program

  46. Berenson RA, Paulus RA, Kalman NS. Medicare's readmissions-reduction program–a positive alternative. N Eng J Med. 2012;366:1364–6.

    Article  CAS  Google Scholar 

  47. Itani K, Webb ALB, Fink AS. Approaches to assessing surgical quality of care. Hosp Physician. 2008;44:29–37.

    Google Scholar 

  48. Cooperberg MR, Birkmeyer JD, Litwin MS. Defining high quality health care. Urol Oncol. 2009;27:411–6.

    Article  PubMed  Google Scholar 

  49. Birkmeyer JD, Dimick JB, Birkmeyer NJ. Measuring the quality of surgical care: structure, process, or outcomes? J Am Coll Surg. 2004;198:626–32.

    Article  PubMed  Google Scholar 

  50. Donabedian A. The quality of care. How can it be assessed? JAMA. 1988;260:1743–8.

    Article  CAS  PubMed  Google Scholar 

  51. Iezzoni LI. An introduction to risk adjustment. The official journal of the American College of Medical Quality. Am J Med Qual. 1996;11:S8–11.

    CAS  PubMed  Google Scholar 

  52. Mehrotra A, Adams JL, Thomas JW, McGlynn EA. The effect of different attribution rules on individual physician cost profiles. Ann Intern Med. 2010;152:649–54.

    PubMed  Google Scholar 

  53. Scholle SH, Roski J, Adams JL, et al. Benchmarking physician performance: reliability of individual and composite measures. Am J Manag Care. 2008;14:833–8.

    PubMed  Google Scholar 

  54. Bozic KJ, Chiu VW, Takemoto SK, et al. The validity of using administrative claims data in total joint arthroplasty outcomes research. J Arthroplasty. 2010;25:58–61.

    Article  PubMed  Google Scholar 

  55. Wadgaonkar AD, Schneider EC, Bhattacharyya T. Physician tiering by health plans in Massachusetts. J Bone Joint Surg Am. 2010;92:2204–9.

    Article  PubMed  Google Scholar 

  56. Birkmeyer JD, Gust C, Baser O, et al. Medicare payments for common inpatient procedures: implications for episode-based payment bundling. Health Serv Res. 2010;45:1783–95.

    Article  PubMed  Google Scholar 

Download references

Disclosure

KJ Bozic: Paid consultant for Blue Cross Blue Shield Association, Integrated Healthcare Association, Pacific Business Group on Health; Y Marjoua: none.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kevin J. Bozic.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Marjoua, Y., Bozic, K.J. Brief history of quality movement in US healthcare. Curr Rev Musculoskelet Med 5, 265–273 (2012). https://doi.org/10.1007/s12178-012-9137-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12178-012-9137-8

Keywords

Navigation