About the National Quality Strategy (NQS)
The National Quality Strategy was first published in March 2011 as the National Strategy for Quality Improvement in Health Care, and is led by the Agency for Healthcare Research and Quality on behalf of the U.S. Department of Health and Human Services (HHS).
Mandated by the Patient Protection and Affordable Care Act, the National Quality Strategy was developed through a transparent and collaborative process with input from a range of stakeholders. More than 300 groups, organizations, and individuals, representing all sectors of the health care industry and the general public, provided comments. Based on this input, the National Quality Strategy established a set of three overarching aims that builds on the Institute for Healthcare Improvement's Triple Aim®, supported by six priorities that address the most common health concerns that Americans face. To align with National Quality Strategy, stakeholders can use nine levers to align their core business or organizational functions to drive improvement on the aims and priorities.
Working Together to Improve Quality
Improving health and health care quality can occur only if all sectors, individuals, family members, payers, providers, employers, and communities, make it their mission. Members of the health care community can align to the National Quality Strategy by doing the following:
Adopt the three aims to provide better, more affordable care for the individual and the community.
Focus on the six priorities to guide efforts to improve health and health care quality.
Use one or more of the nine levers to identify core business functions, resources, and/or actions that may serve as means for achieving improved health and health care quality.
To learn more about the National Quality Strategy's impact on the nation's health and health care, review the 2013 Annual Progress Report, visit the Priorities in Action section, or view a past webinar for examples of quality improvement efforts that align to the NQS.
Measure Alignment
The National Quality Strategy also provides a focus for addressing the abundance of clinical quality measures currently used in national programs. The goal is to get to measures that matter and minimize provider burden. The HHS Measurement Policy Council was convened in early 2012 to begin the work of aligning measures across HHS. Composed of senior-level representatives from Agencies and operating divisions across HHS, the group also addresses new measure development and implementation, and measurement policy. The Council has so far reviewed nine topics to date: hypertension control, hospital-acquired conditions/patient safety, HCAHPs, smoking cessation, depression screening and care coordination, HIV/AIDS, perinatal, and obesity/BMI. The core measure sets that the Measurement Policy Council developed for each topic can be viewed here: (PDF File, 257 KB; PDF Help).
While these measures are used for Federal programs, the Measurement Policy Council supports State and private-sector efforts to adopt core measure sets for further harmonization and alignment across the health and health care community.
Aims
The National Quality Strategy pursues three broad aims. These aims will be used to guide and assess local, State, and national efforts to improve health and the quality of health care.
- Better Care: Improve the overall quality, by making health care more patient-centered, reliable, accessible, and safe.
- Healthy People/Healthy Communities: Improve the health of the U.S. population by supporting proven interventions to address behavioral, social and, environmental determinants of health in addition to delivering higher-quality care.
- Affordable Care: Reduce the cost of quality health care for individuals, families, employers, and government.
Setting Priorities
To advance these aims, the National Quality Strategy focuses on six priorities:
- Making care safer by reducing harm caused in the delivery of care.
- Ensuring that each person and family is engaged as partners in their care.
- Promoting effective communication and coordination of care.
- Promoting the most effective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular disease.
- Working with communities to promote wide use of best practices to enable healthy living.
- Making quality care more affordable for individuals, families, employers, and governments by developing and spreading new health care delivery models.
Using Levers
Each of the nine National Quality Strategy levers represents a core business function, resource, and/or action that stakeholders can use to align to the Strategy. In many cases, stakeholders may already be using these levers but haven't connected these activities to National Quality Strategy alignment.
- Measurement and Feedback: Provide performance feedback to plans and providers to improve care
- Public Reporting: Compare treatment results, costs and patient experience for consumers
- Learning and Technical Assistance: Foster learning environments that offer training, resources, tools, and guidance to help organizations achieve quality improvement goals
- Certification, Accreditation, and Regulation: Adopt or adhere to approaches to meet safety and quality standards
- Consumer Incentives and Benefit Designs: Help consumers adopt healthy behaviors and make informed decisions
- Payment: Reward and incentivize providers to deliver high-quality, patient-centered care
- Health Information Technology: Improve communication, transparency, and efficiency for better coordinated health and health care
- Innovation and Diffusion: Foster innovation in health care quality improvement, and facilitate rapid adoption within and across organizations and communities
- Workforce Development: Investing in people to prepare the next generation of health care professionals and support lifelong learning for providers
Priorities in Action
Priorities in Action features some of our nation's most promising and transformative quality improvement programs, and describes their alignment to the NQS' six priorities. Updated monthly, these programs represent private sector, Federal, State, and local efforts.
We want to hear from you! If your program aligns with the priorities, email NQStrategy@ees.hhs.gov with details.
Inclusion in the Priorities in Action program listing does not constitute endorsement by the U.S. Department of Health and Human Services.
To expand/collapse the full description of any program below, please select the link labeled (more...).
Established in 2000, the Oregon Healthcare Quality Corporation is an independent nonprofit organization dedicated to improving the quality and affordability of health care in Oregon by leading community collaborations and producing unbiased public reporting information. The Oregon Health Care Quality Corporation works with the members of the community—including consumers, providers, employers, policymakers, and health insurers—to improve the health of all Oregonians and finds solutions to Oregon's health care challenges, such as reducing unnecessary emergency department visits.Oregon Health Care Quality Corporation (more...)
In 2007, northeast Ohio health care systems, health plans, employer groups, and community organizations established Better Health Greater Cleveland to improve health and health care while reducing costs. The collaborative develops and disseminates evidence-based care transformation strategies focused on primary care for chronic conditions, including diabetes, high blood pressure, and heart failure. Across the region, the collaborative's programs have helped more than 700 primary care providers from 12 health care systems adopt patient-centered models of care, use electronic health records more effectively, and regularly measure care to identify opportunities to continuously improve.
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The Reginald S. Lourie Center for Infants and Young Children is a nationally recognized pioneer, incubator, and disseminator of evidence-based treatments and best practices in the field of early childhood development, prevention of emotional or behavioral disorders, and intervention. The Lourie Center seeks to improve the social and emotional health of young children and families through prevention, early intervention, education, research and training. The Lourie Center serves 4,000 children and families in the Washington, DC, metropolitan area. Approximately 80 percent of the families it serves are enrolled in Medicaid. The Center's programs are designed to strengthen families, help young children and parents/caregivers develop increasingly secure relationships, and support the social and emotional competencies needed for success in life.
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The Wisconsin Collaborative for Healthcare Quality (WCHQ) is a voluntary, statewide consortium of physician groups, hospitals, health plans, and employers working together to improve health and the quality and affordability of health care in Wisconsin. WCHQ members publicly report an agreed-upon set of performance measures related to the services that they provide, enabling the collaborative to produce comparative reports on health care quality and patient experience. As a result, practices are able to identify areas for improvement within their own organization and build the capacity to do so through the forums convened and facilitated by the Collaborative to share successes and challenges with others.
Studies by the Agency for Healthcare Research and Quality have shown that the sickest 5 percent of U.S. patients account for over half of the country's health care costs. These "high utilizers" often suffer from multiple chronic conditions and take many medications. The Camden Coalition of Healthcare Providers (CCHP) provides a model for effective, efficient care for the highest utilizers in the community it serves, improving the health of the community while reducing the cost of care. The CCHP has accomplished this by identifying high utilizers through analyzing local claims data and providing them with well-coordinated care through a personalized care management system. By combining typical health care services such as primary care and chronic care management with social support and behavioral health interventions, the CCHP addresses the full spectrum of factors that influence health.
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The Colorado Beacon Consortium brings together physician leaders, hospitals, a community-based health information exchange, and a local payer to develop and implement new ways to improve the quality and patient experience of health care while controlling costs. The region-wide alliance strengthens the existing health information technology infrastructure and advances patient-centered primary care, to provide better care for the 320,000 patients the Consortium serves.
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Launched in 2000, the Healthy Hawaii Initiative is a statewide effort to prevent and control chronic disease, extend and increase the quality of Hawaiians' years of life, and address health disparity. The program targets behavior change at the individual level, and addresses the social determinants of health that are influenced by organizations and the community. The initiative is made up of five interrelated components that promote healthy and active living among Hawaii's 1.4 million residents, targeting schools, community organizations, and organizations involved in public and professional education. The program also works to improve detection, treatment, and management of heart disease, stroke, cancer, diabetes, and asthma.
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In 2003, the Michigan Health and Hospital Association (MHA) Keystone Center, with funding from the Agency for Healthcare Research and Quality (AHRQ), organized a large-scale collaboration effort among Michigan's health and health care stakeholders, including hospitals, State government, payers, and employers. With these partners, the MHA Keystone Center forged evidence-based solutions that improve the quality of care offered to Michigan's residents. Many of the patient safety interventions developed by the MHA Keystone Center are now being used throughout the nation and around the world.
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The New York State Health Foundation's Diabetes Campaign, "Reversing the Trend," seeks to address one of the State's most pervasive epidemics—diabetes. Nearly 10 percent of New Yorkers—or 1.4 million—are afflicted with this disease, and almost 4 million more suffer from prediabetes, causing harm to a significant portion of the State's population. Additionally, diabetes costs the State almost $13 billion a year in health care costs and productivity losses. The New York State Health Foundation, or NYSHealth, developed a three-pronged strategy to attack diabetes: (1) improve the way New York physicians treat chronic disease, (2) develop community-based prevention and management initiatives, and (3) progressively transform the chronic care system to a pay-for-performance mode.
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The Patient Safety and Clinical Pharmacy Services Collaborative (PSPC), organized by the Health Resources and Services Administration, or HRSA, improves health care quality by providing patients suffering from complex conditions with evidence-based clinical pharmacy services. Now in its fifth year, PSPC works with teams of community health care providers to advance their medication and care management systems and improve patient safety.
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The Patient-Centered Medical Home (PCMH) model holds promise as a means to improve health and health care in America by transforming how primary care is organized, delivered, and funded. Building on the work of a large and growing community, the Agency for Healthcare Research and Quality (AHRQ) envisions the PCMH as a model of primary care that delivers patient–centered, high–quality care safely and efficiently through improved communication and coordination.
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Initiated in late 2009, this grant-funded program seeks to help reverse the childhood obesity epidemic, especially in lower-income communities and in populations at greatest risk. It provides four years of grant funding and technical assistance to 49 multidisciplinary partnerships across the country to implement policies, systems, and environmental change strategies to create sustainable community change.
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In 2010, the Health Resources and Services Administration (HRSA) launched the Flex Medicare Beneficiary Quality Improvement Program to improve the quality of care for Medicare beneficiaries served by critical access hospitals (CAHs). CAHs are rural community hospitals that have 25 or fewer inpatient beds, are at least 35 miles from another facility or are designated as a necessary providers, and receive cost-based reimbursement from Medicare and, in some states, Medicaid. This program helps CAHs prioritize quality measurement and improvement despite their limited resources and staff. In the post-health reform environment, CAHs may soon be compared with their urban counterparts to ensure public confidence in their quality of health services. This initiative enables CAHs to demonstrate the quality of care they provide.
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