April 2004

Grant Results

SUMMARY

From 1998 to 2000, a 20-member Forum Planning Committee appointed by Vice President Al Gore planned and established the National Forum for Health Care Quality Measurement and Reporting (now called the National Quality Forum).

As the nation's first nonprofit, membership-based, standard-setting body for health care quality, the forum has the goal of changing how health care quality information is collected and used in the United States.

Key Results
The National Quality Forum accomplished the following:

  • Developed a formal Consensus Development Process, which assures that the standards it adopts and puts forth are "voluntary consensus standards."
  • Applied its Consensus Development Process in the development of six consensus reports.
    • Serious Reportable Events in Healthcare identifies 27 adverse events that are "serious, largely preventable, and of concern to both the public and health care providers."
    • A National Framework for Healthcare Quality Measurement and Reporting "provides short-term operational guidance that will be used when selecting performance measures;… identifies longer-term strategic areas that the [National Quality Forum] will pursue; and sets forth policy statements that are important to improving healthcare quality."
    • National Voluntary Consensus Standards for Adult Diabetes Care categorizes consensus standards by area (e.g., urine protein testing, eye examination) and includes both external and internal quality measures.
    • A Comprehensive Framework for Hospital Care Performance Evaluation gives "guiding principles for hospital measurement and reporting that can be uniformly adopted and applied by hospitals, regulators and other stakeholders in order to standardize these essential activities."
    • Safe Practices for Better Healthcare "details 30 healthcare practices that should be universally utilized in applicable clinical care settings to reduce the risk of harm to patients."
    • National Voluntary Consensus Standards for Hospital Care: An Initial Performance Measurement Set, according to the forum, provides the "first-ever set of nationally standardized measures to assess the quality of care provided by the more than 6,000 acute care hospitals in the U.S."

Funding
The Robert Wood Johnson Foundation (RWJF) supported this project through three grants totaling $2,844,439, including two grants to the United Hospital Foundation of New York, the fiduciary representative and coordinating body for the forum in its planning stage, and one to the National Quality Forum itself.

 See Grant Detail & Contact Information
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THE PROBLEM

Studies have documented significant problems in the U.S. health care system — including overuse, underuse, and misuse of health care services. In fact, a 1998 Institute of Medicine National Roundtable on Health Care Quality stated that "problems in health care delivery are serious and extensive" and require "urgent action."

To improve the nation's health care, standardized quality measures are critical. They can:

  • Motivate organizations to improve their health care delivery.
  • Track the health care industry's quality improvement progress.
  • Guide public planning and policy-making.
  • Guide consumers and employers in their health care provider and health plan selection.
  • Inform health care providers' quality improvement programs.

Despite both private and public sector initiatives over the past decade to develop such standardized measures, existing quality measurement and reporting tools lack uniformity — and tend to be unduly burdensome for health care providers and health plans. In addition, these tools do not include measures for many of the most important health care needs, such as treatment of chronic conditions.

Recognizing this quality measurement gap, President Bill Clinton in September 1996 created a bipartisan Advisory Commission on Consumer Protection and Quality in the Health Care Industry. The 32-member commission, co-chaired by Donna Shalala, U.S. Secretary of Health and Human Services, and Alexis Herman, U.S. Secretary of Labor, recommended in its final report to President Clinton in 1998 the creation of the Forum for Health Care Quality Measurement and Reporting.

This private sector body would "harness the power of private employers, public programs, consumers, health care practitioners, health plans, accreditation bodies, and others to establish a core set of quality measures that would provide the public with clear indications of the quality of care available to them."

The forum was to work side-by-side with a public sector body, the Advisory Council on Health Care Quality, which would identify, recommend strategies for, and track the progress of national priorities for quality improvement. Congress never passed legislation to establish the advisory council.

Planning for the forum was the primary responsibility of the Quality Forum Planning Committee, whose members were appointed by Vice President Al Gore in August 1998 (see Appendix 1 for a list of members).

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RWJF STRATEGY

When the Advisory Commission on Consumer Protection and Quality in the Health Care Industry released its report to President Clinton in March 1998 and proposed the creation of the private sector Forum for Health Care Quality Measurement and Reporting, it did not include recommendations for appropriating funds to support the initiative. Therefore, members of the Forum Planning Committee looked to foundations for grant monies.

The United Hospital Foundation of New York, the fiduciary representative and coordinating body for the forum in its planning stage, approached RWJF about providing funding for the development and implementation of the forum. RWJF was one of the founding funders of the National Quality Forum.

RWJF was initially cautious about funding the forum out of concern that the White House would position the effort as a partisan initiative. Approval of funding was delayed until after the White House press conference announcing the forum's creation. RWJF staff attended the event, observed the neutral tone of the forum, and the RWJF's Board subsequently approved the initial planning grant.

RWJF was also involved with the issue of quality through a number of other grants during the course of this project. For example, in 2000, with RWJF funding, researchers from Georgetown University developed measures to assess the process of care provided to Medicaid-enrolled children with asthma living in Massachusetts.

The research team developed these measures based on the most current national guidelines for pediatric asthma. They then applied these measures to Medicaid and health maintenance organization data to study the extent to which care provided to children with asthma in different Medicaid settings follows national guidelines for appropriate asthma care — and whether differences in the process of care are associated with different rates of hospitalization. See Grant Results on ID# 037307.

In 2002, RWJF supported to the National Coalition on Health Care and the Institute for Healthcare Improvement to produce and disseminate two reports profiling model strategies for managing chronic disease and providing care in the intensive care unit (ICU). The reports were part of a broader initiative by the two organizations, "Accelerating Change Today — For America's Health," aimed at encouraging health care providers and purchasers to adopt "best practices." See Grant Results on ID# 043117.

In February 2002, RWJF also started a national program, Rewarding Results: Aligning Incentives with High-Quality Health Care, which seeks to invent, prove and diffuse innovations in systems of provider payments and nonfinancial incentives that will encourage and reward high-quality care (for more information see Grant Results). It is led by the Leapfrog Group, whose members are leaders of private-sector efforts to improve quality. It is the follow-up program to an earlier effort in the same vein, the Health Care Purchasing Institute.

Although RWJF does not have an explicit quality goal in its grantmaking mission, in 2003 two of RWJF's four goal areas were changed to address issues related to health care quality:

  • To assure that all Americans have access to quality health care at reasonable cost.
  • To improve the quality of care and support for people with chronic health conditions.

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THE PROJECT

The project established a new national organization, the National Forum for Health Care Quality Measurement and Reporting (later renamed the National Quality Forum), with the goal of changing how health care quality information is collected and used in the United States.

The National Quality Forum is the first nonprofit, membership-based, standard-setting body for health care quality. Its mission is to "improve American healthcare through endorsement of consensus-based national standards for measurement and public reporting of healthcare performance data that provide meaningful information about whether care is safe, timely, beneficial, patient-centered, equitable and efficient."

The forum's core activities fall into three broad categories:

  1. Consensus development projects.
  2. Convening.
  3. Leadership and consciousness-raising activities.

Its activities relate to a specific population, condition, service line or cross-cutting care issue (e.g., pain management or patient safety). To address these issues, the forum brings together a diverse group of health care stakeholders to develop consensus on core measures of health care quality. Consumers and patient groups, health care purchasers, health care providers, health plans, and research and quality improvement organizations provide feedback and guidance as the forum's Consensus Development Process moves standards from a draft version to National Quality Forum-adopted voluntary consensus standards.

The intent of the forum is to work collaboratively and constructively with other organizations involved in health care measurement and reporting, especially the Joint Commission on Accreditation of Health Care Organizations and the National Committee on Quality Assurance, to standardize existing quality measures, rather than to develop new quality indicators.

The 20-member Forum Planning Committee (appointed by Vice President Al Gore), with the United Hospital Fund of New York acting as its convener and fiduciary representative, created a blueprint for the forum. This blueprint outlined:

  • The forum's mission, functions, operations, working relationships with other private and public sector organizations, and membership criteria.
  • The composition and structure of the forum's governing board.
  • Sources of short- and long-term financing.
  • A strategy for making the transition from planning committee to the National Quality Forum, including a process for recruiting an executive director.

The planning committee met six times from June 1998 to March 1999 in Washington or New York City. All meetings were open to the public (with the exception of the first convening meeting at the White House) and included a period for public comment. As part of its work, the planning committee invited representatives of many major national organizations involved in quality measurement (e.g., Joint Commission on Accreditation of Healthcare Organizations, Institute of Medicine, Agency for Healthcare Research and Quality, National Committee for Quality Assurance, Foundation for Accountability, and Centers for Medicare & Medicaid Services) to present their respective priorities and activities, and discuss their expectations for the forum.

At the culmination of the planning phase for the forum, the newly incorporated organization held the first meeting of its board of directors in May 1999 (see Appendix 2 for a complete list of board members). The heads of three federal government agencies — the Centers for Medicare & Medicaid Services, the Agency for Healthcare Research and Quality, and the Office of Personnel Management — sit on the 23-member board, as do representatives of state agencies and private-sector businesses, such as General Motors, the largest private purchaser of health care in the United States. The forum became fully operational in February 2000.

The United Hospital Fund, directed by its president, James Tallon, convened and managed the planning committee. Tallon was selected as a neutral convener for the forum planning effort because he has a national reputation and expertise in health care policy, but is not a stakeholder in the health care quality measurement and improvement field. Tracy Miller, Ph.D., then clinical associate professor in the Mount Sinai Department of Health Policy, served as director of the planning committee under a contract with the United Hospital Fund.

Working with the Lewin Group, a national health care and human service consulting firm, the planning committee recruited a president, Kenneth W. Kizer, M.D., M.P.H.

The Henry J. Kaiser Family Foundation, the Commonwealth Fund, the California Healthcare Foundation and the Horace W. Goldsmith Foundation also provided support for the planning and start-up phases for the forum. United Hospital Fund provided in-kind support, including administrative and professional staff time.

From 1999 through early 2003, a number of other organizations and agencies supported the forum, including the Department of Veterans Affairs, the Agency for Healthcare Research and Quality, Centers for Medicare & Medicaid Services, Milbank Memorial Fund, National Health Care Purchasing Institute, and Pacific Business Group on Health. Some of this funding supported specific activities, while other funding, such as that provided by the Department of Veterans Affairs, supported the day-to-day operations of the forum.

The National Quality Forum was designed as a membership organization, with annual dues providing revenue to support its operations. As of December 2003, the forum had 202 members.

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RESULTS

During the period of the RWJF planning and implementation grants, the forum accomplished the following:

  • The National Quality Forum developed a formal Consensus Development Process, which assures that the standards it adopts and puts forth — including performance measures, quality indicators and preferred practices or reporting guidelines — are "voluntary consensus standards." The process has been approved by both the Agency for Healthcare Research and Quality and the Centers for Medicare & Medicaid Services, and is consistent with the voluntary consensus procedures for standards development specified in the National Technology Transfer and Advancement Act of 1995. The act states that when a federal government agency establishes standards in an area, it is obligated to "use voluntary consensus standards in lieu of government unique standards except where inconsistent with law or otherwise impractical." The forum's voluntary consensus standards undergo multiple levels of review and approval:
    1. A steering or review committee composed of individuals from the four major stakeholder groups (consumers and patients, health care purchasers, health care providers and health plans, and research and quality improvement organizations) assesses the state of the field in a particular topic area (e.g., diabetes care, hospital care) recommends a draft set of quality measures, indicators or practices.
    2. The forum disseminates these measures for review and comment by forum members and the general public. After the comment period, forum members vote on the revised recommendations.
    3. Following approval by forum members, the forum board of directors — including its four member councils (providers and health plans, consumers, researchers, and quality improvement organizations) — votes on the measures and endorses them as voluntary consensus standards. The complete Consensus Development Process is explained on the forum's Web site.
  • During the period of the RWJF grant, the forum applied its Consensus Development Process in the development of six consensus reports.
    1. Serious Reportable Events in Healthcare, endorsed in late 2001, published in 2002 and disseminated to 2,400 individuals and organizations, builds upon an earlier report by the Institute of Medicine, To Err Is Human. That report concluded that preventable medical errors are a leading cause of death in America and recommended mandatory, systematic reporting of health care errors at the state level. A report by the Quality Interagency Coordination Task Force to the President, Doing What Counts for Patient Safety: Federal Action to Reduce Medical Errors and their Impact, also informed the forum's work. Serious Reportable Events in Healthcare identifies 27 adverse events that are "serious, largely preventable, and of concern to both the public and health care providers." The events are grouped into six categories:
      1. Surgical.
      2. Product or device.
      3. Patient protection.
      4. Care management.
      5. Environmental.
      6. Criminal acts.

      The forum recommends that states adopt this list of serious reportable events as a starting point for a national state-based event reporting system that ultimately will provide "both caregivers and consumers with important information about the safety of health care and opportunities for improvement." Whether or how this data is disclosed to the public is a state policy decision, although the forum recommends "at least some degree of public disclosure." The forum convened a steering committee and a special advisory panel of government representatives to guide the consensus development process (see Appendix 3 for a list of members). RWJF, Milbank Memorial Fund, the Agency for Healthcare Research and Quality, Centers for Medicare & Medicaid Services, California HealthCare Foundation, Horace W. Goldsmith Foundation, Department of Veterans Affairs and United Hospital Fund of New York supported the project. The full report is available through the National Quality Forum's Web site at a cost of $8 for forum members and $12 for nonmembers.

      RWJF simultaneously awarded a series of grants to the National Academy for State Health Policy in Portland, Maine, (see Grant Results on ID#s 38842, 42233 and 46686) to:
      1. Examine successful state-based efforts to report medical errors.
      2. Disseminate this information to state policy officials to assist them with developing their own strategies to reduce medical errors and improve patient safety.
      3. Develop and disseminate a standardized list of medical errors for use in a state-based mandatory reporting system.

      The academy worked with the National Quality Forum to translate current state-reported adverse events into a form comparable to the forum's list of 27 adverse events. The California HealthCare Foundation, the Commonwealth Fund, and the Agency for Healthcare Research and Quality also supported the academy's work.
    2. A National Framework for Healthcare Quality Measurement and Reporting, published in the summer of 2002 and disseminated to 1,400 individuals and organizations, is based in part on the work of the forum's Strategic Framework Board, a nine-member group of nationally recognized quality improvement and health care experts (see Appendix 4 for a list of Strategic Framework Board Members). The report presents 17 recommendations (four principles, five strategic priorities and eight policy statements) endorsed by the forum. The framework "provides short-term operational guidance that will be used when selecting performance measures; …identifies longer-term strategic areas that the [National Quality Forum] will pursue; and sets forth policy statements that are important to improving healthcare quality." RWJF, California HealthCare Foundation, Horace W. Goldsmith Foundation, Department of Veterans Affairs, Centers for Medicare & Medicaid Services, Agency for Healthcare Research and Quality, Office of Personnel Management, United Hospital Fund of New York and the Commonwealth Fund supported the project. The full report is available through the National Quality Forum's Web site at a cost of $8 for forum members and $12 for nonmembers.
    3. National Voluntary Consensus Standards for Adult Diabetes Care, published in the Summer of 2002 and disseminated to 1,160 individuals and organizations, is based on earlier work by the Diabetes Quality Improvement Project (a joint effort of the Centers for Medicare & Medicaid Services, the American Diabetes Association, the National Committee for Quality Assurance and the Foundation for Accountability) and the American Medical Association/Joint Commission on Accreditation of Healthcare Organizations/National Committee for Quality Assurance Core Measurement Set for Management of Adult Diabetes project. Their efforts resulted in the development of two standardized sets of performance measures, which were similar but not identical. Both groups of developers subsequently collaborated in early 2002, calling themselves the National Diabetes Quality Improvement Alliance, and produced a single performance measurement set for adult diabetes outpatient care. The National Quality Forum convened the Diabetes Measures Review Committee (see Appendix 5 for a list of members), which examined the measures and guided them through the forum's Consensus Development Process. The consensus standards are categorized by area (e.g., urine protein testing, eye examination) and include within each area external accountability measures and internal quality improvement measures. RWJF, California HealthCare Foundation, Horace W. Goldsmith Foundation and the Department of Veterans Affairs supported the project. The full report is available through the National Quality Forum's Web site at a cost of $9.50 for forum members and $14 for nonmembers.
    4. A Comprehensive Framework for Hospital Care Performance Evaluation, published in 2003 and disseminated to 1,500 individuals and organizations, "articulates guiding principles for hospital measurement and reporting that can be uniformly adopted and applied by hospitals, regulators, and other stakeholders in order to standardize these essential activities." This framework adapts the National Quality Forum-endorsed priorities and principles presented in A National Framework for Healthcare Quality Measurement and Reporting (see above) to make them specific to hospital performance measurement. The forum convened the Hospital Care Performance Measures Steering Committee and three working groups (see Appendix 6 for a list of members), which developed three Guiding Principles that will focus the forum's efforts in this area and six Recommendations for Voluntary Consensus Standards for Hospital Care. RWJF, the Agency for Healthcare Research and Quality, Centers for Medicare & Medicaid Services, California HealthCare Foundation, Horace W. Goldsmith Foundation, Department of Veterans Affairs, United Hospital Fund of New York and the U.S. Office of Personnel Management supported this project. The full report is available through the National Quality Forum's Web site at a cost of $18.50 for forum members and $27.75 for nonmembers.
    5. Safe Practices for Better Healthcare, published in 2003 and disseminated to 1,200 individuals and organizations, "details 30 healthcare practices that should be universally utilized in applicable clinical care settings to reduce the risk of harm to patients." These 30 practices were culled from an original pool of approximately 220 based on five criteria — their specificity, benefit, evidence of effectiveness, generalizability and readiness for implementation. The 30 practices are based, in part, on the some of the practices from the report, Making Health Care Safer: A Critical Analysis of Patient Safety Practices, by the University of California San Francisco-Stanford University Evidence-Based Practice Center (funded by the Agency for Healthcare Research and Quality) and work by the Leapfrog Group, a Washington-based group of public and private organizations providing health care benefits that uses their combined expertise to identify ways to improve hospital care (supported by RWJF grant ID#s 047612 and 48535). The Leapfrog Group is managing the RWJF national program, Rewarding Results: Aligning Incentives with High-Quality Health Care, which helps Fortune-500 companies, Medicare and other purchasers learn and share ways to improve health care quality (for more information see Grant Results). In response to the forum's open call for suggested safe practices, more than 120 medical specialty, nursing, pharmacy and other organizations provided input on the list of practices. The Safe Practices Project Steering Committee guided the deliberations, assisted by an advisory panel convened to address issues specifically related to the dissemination, implementation and use of the set of safe practices (see Appendix 7 for a list of steering committee and advisory panel members). The report also includes 27 practices that may potentially reduce adverse events, but require further investigation. RWJF, California HealthCare Foundation, Agency for Healthcare Research and Quality, Centers for Medicare & Medicaid Services, Horace W. Goldsmith Foundation, Department of Veterans Affairs, United Hospital Fund of New York and the U.S. Office of Personnel Management supported the project. The full report is available through the National Quality Forum's Web site at a cost of $25.50 for forum members and $38.50 for nonmembers.
    6. National Voluntary Consensus Standards for Hospital Care: An Initial Performance Measurement Set, published in 2003 and disseminated to 1,000 individuals and organizations, presents and explains an initial set of 39 measures for hospital care performance. The forum began to identify national voluntary consensus standards for hospital care in 2001, at the request of the Centers for Medicare & Medicaid Services and the Agency for Healthcare Research and Quality. According to the report, they are the "first-ever set of nationally standardized measures to assess the quality of care provided by the more than 6,000 acute care hospitals in the U.S." and are intended to promote "both public accountability and internal quality improvement." The forum convened a steering committee, which developed the approach of focusing the performance measures on specific areas of hospital care, and a workshop at which experts in hospital care and quality measurement provided feedback on the proposed measures (see Appendix 6 for a list of members and participants). This initial set of performance measures, which was drawn from existing national and state performance measures, focuses on eight priority areas:
      • Acute coronary syndrome
      • Heart failure
      • Patient safety
      • Pediatric conditions
      • Pneumonia
      • Pregnancy/childbirth/neonatal conditions
      • Smoking cessation
      • Surgical complications

RWJF, the Agency for Healthcare Research and Quality, Centers for Medicare & Medicaid Services, California HealthCare Foundation, Horace W. Goldsmith Foundation, Department of Veterans Affairs, United Hospital Fund of New York and U.S. Office of Personnel Management supported the project. The full report is available through the National Quality Forum's Web site at a cost of $22 for forum members and $33 for nonmembers.

After the release of National Voluntary Consensus Standards for Hospital Care, the forum hosted a national summit to address strategies to support implementation and public disclosure of the measures. A diverse group of hospital teams and health care leaders attended the summit and the forum published the proceedings from their discussion, Reaching the Tipping Point: Measuring the Reporting Quality Using the NQF-Endorsed Hospital Care Measures, in the summer of 2003. RWJF supported the effort through its grant to AcademyHealth, which at the time was running the National Health Care Purchasing Institute, a precursor to the Rewarding Results RWJF national program. The summit proceedings are available through the National Quality Forum's Web site at a cost of $9.75 for forum members and $14.75 for nonmembers.

Other Results

During the period of RWJF funding, the forum examined health care quality issues in the following additional areas with funding from other organizations.

  • With funding from the Commonwealth Fund, the forum held a workshop on Improving Healthcare Quality for Minority Populations in June 2001. The workshop proceedings, which include eight recommendations for reducing disparities in health care quality for minorities, are available through the National Quality Forum's Web site at a cost of $17 for forum members and $25.50 for nonmembers.
  • With the Institute of Medicine, the forum convened a National Summit on Information Technology and Healthcare Quality in March 2002 to develop an action plan for defining the governance, operating standards and funding of a national health care information infrastructure. The Veterans Health Administration, Kaiser Foundation Health Plan, U.S. Army Medical Research and Materiel Command, Centers for Medicare & Medicaid Services, Agency for Healthcare Research and Quality, Centers for Disease Control and Prevention, Cerner Corporation, McKesson Corporation, Eclipsys Corporation, National Cancer Institute, College of Healthcare Information Management Executives, National Institute for Health Care Management, eHealth Initiative, and National Committee on Vital and Health Statistics also provided support. The summit proceedings are available through the National Quality Forum's Web site at a cost of $13 for forum members and $19.50 for nonmembers.

Tributes

Since the forum's inception in 1999, the health care field has come to acknowledge it as the national arbiter of health care quality measurement. Even for-profit organizations with proprietary health care quality measurement tools submit them to the forum for their "seal of approval" — although in doing so the tools are open to public scrutiny and use. Both Tommy G. Thompson, current U.S. Secretary of Health and Human Services, and Carolyn M. Clancy, M.D., director of the Agency for Healthcare Research Quality, acknowledged the value of the forum's contribution in the specific area of patient safety standards:

Tommy G. Thompson: "I commend the members of the National Quality Forum for their important work in identifying an initial set of 30 key patient safety practices. Dr. Kenneth W. Kizer and all the members of the Forum have performed an invaluable service in identifying these systematic approaches to help ensure safety and quality of care…Our long-term goal is to ensure that the American people have the highest quality, safest health care system possible. The report…is an important step in meeting that goal."

Carolyn M. Clancy, M.D.: "If health care leaders work to implement this important set of voluntary consensus standards, it will go a long way toward preventing medical errors and improving patient safety. This report, along with the findings from continuing patient safety research sponsored by the Agency for Healthcare Research Quality, will help make the nation's health care system a lot safer."

Communications

Establishing the forum depended in significant part on attaining national prominence. Toward that end, forum President and CEO Kizer spoke extensively at national meetings and published articles in peer-reviewed journals — including the Journal of the American Medical Association and Academic Emergency Medicine — and in more general health care news magazines. The forum launched a member newsletter in summer 2000. The forum published six consensus reports (described above), distributed complimentary copies to all forum members and key policy-makers, and sold additional copies through its Web site. These reports received significant media coverage in U.S. News & World Reports, Modern Healthcare and Reuters Health.

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LESSONS LEARNED

  1. Supporting the activities of a committee composed of national health care leaders requires significant staffing resources. The United Hospital Fund, as the convener of the Forum Planning Committee, underestimated the amount of staff work required to produce briefing books for each meeting, coordinate travel and lodging for committee members, and arrange and oversee the meetings. To meet these needs, United Hospital Fund allocated additional staff resources that were not covered by the grant. (Project Director/Tallon)
  2. When creating an organization in any field that seeks to standardize quality measurement tools, including leaders and key stakeholders in the planning process is essential to gaining buy-in. The Forum Planning Committee included national consumer, employer, health care provider and government leaders. In addition, planning committee meetings featured presentations from major national organizations involved in quality measurement to consider their perspectives and priorities in planning efforts. (Project Director/Tallon)
  3. You must secure core grant funding to support start-up activities for a new membership-based national organization. With a stable source of funding in place, founders can devote their time to developing the organization's identity and mission rather than concentrating on recruitment and revenue generation. Founders often must recruit from among skeptics and organizations that have little or no idea of the unique mission and mandate of the start-up organization, and engage members at a time when activities are few and products/services are still several years out. (Project Director/Nishimi)

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AFTER THE GRANT

The forum continues to build its membership base and pursue other sources for stable core funding. Currently, the forum is developing additional consensus reports for nursing home care, home health care, cancer care, mammography screening, cardiac surgery and a patient safety taxonomy, with planning activities for behavioral health and child health.

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GRANT DETAILS & CONTACT INFORMATION

Project

Establishment of the National Forum for Health Care Quality Measurement and Reporting

Grantee

United Hospital Fund of New York (New York,  NY)

  • Planning to Establish the National Forum for Health Care Quality Measurement and Reporting
    Amount: $ 344,850
    Dates: August 1998 to May 1999
    ID#:  034839

  • Establishment of the National Forum for Health Care Quality Measurement and Reporting
    Amount: $ 358,589
    Dates: May 1999 to May 2000
    ID#:  036668

Grantee

National Quality Forum (Washington,  DC)

  • Establishment of the National Forum for Health Care Quality Measurement and Reporting
    Amount: $ 2,141,000
    Dates: June 2000 to February 2003
    ID#:  039645

Contact

Robyn Y. Nishimi, Ph.D.
(202) 783-1300
info@qualityforum.org

Web Site

http://www.qualityforum.org

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APPENDICES


Appendix 1

(Current as of the time of the grant; provided by the grantee organization; not verified by RWJF.)

Quality Forum Planning Committee

Carmella Bocchino
Vice President of Medical Affairs
American Association of Health Plans
Washington, D.C.

Bruce E. Bradley
Director, Managed Care Plans
General Motors Corporation
Detroit, Mich.

Nancy-Ann Min DeParle
Administrator
Health Care Financing Administration (now Centers for Medicare & Medicaid Services)
Baltimore, Md.

John Eisenberg, M.D.
Administrator
Agency for Healthcare Research and Policy
Rockville, Md.

Mary Jane England, M.D.
President
Washington Business Group on Health
Washington, D.C.

Janice R. Lachance
Director
U.S. Office of Personnel Management
Washington, D.C.

David M. Lawrence, M.D.
Chairman and CEO
Kaiser Foundation Health Plan
Oakland, Calif.

Joe W. Laymon
Director, Human Resources
Vice President, U.S. and Canada Services
Eastman Kodak Company
Rochester, N.Y.

Sheila Leatherman
Executive Vice President
UnitedHealth Group
Minneapolis, Minn.

Judith L. Lichtman
President
National Partnership for Women and Families
Washington, D.C.

Brian W. Lindberg
Executive Director
Consumer Coalition for Quality Health Care
Washington, D.C.

Beverly L. Malone, Ph.D., R.N., F.A.A.N.
President
American Nurses Association
Washington, D.C.

Leslie R. Kramerich
Deputy Assistant Secretary
U.S. Department of Labor
Washington, D.C.

Paul M. Montrone, Ph.D.
Chairman and CEO
Fisher Scientific International
Hampton, N.H.

Patricia M. Nazemetz
Director, Total Pay
Xerox Corporation
Stamford, Conn.

Patricia E. Powers
Executive Director
Pacific Business Group on Health
San Francisco, Calif.

Christopher Queram
CEO
Employer Health Care Alliance Cooperative
Madison, Wis.

Thomas R. Reardon, M.D.
President Elect
American Medical Association
Chicago, Ill.

John Rother
Director, Legislation and Public Policy Division
AARP
Washington, D.C.

Gerald M. Shea
Assistant to the President for Government Affairs
AFL-CIO
Washington, D.C.

Gregg C. Sylvester, M.D.
Cabinet Secretary
Delaware Health and Social Services
New Castle, Del.

James R. Tallon, Jr. (Executive Director)
President
United Hospital Fund of New York
New York, N.Y.

Peter W. Thomas, J.D.
Principal
Powers, Pyles, Sutter & Verville
Washington, D.C.

Gail L. Warden (Chair)
President and CEO
Henry Ford Health System
Detroit, Mich.


Appendix 2

(Current as of the time of the grant; provided by the grantee organization; not verified by RWJF.)

National Quality Forum Board of Directors

Gail L. Warden (Chair)
President Emeritus
Henry Ford Health System
Detroit, Mich.

William L. Roper, M.D., M.P.H. (Vice-Chair)
Dean
University of North Carolina School of Public Health
Chapel Hill, N.C.

John O. Agwunobi, M.D., M.B.A.
Secretary
Florida Department of Health
Tallahassee, Fla.

Harris A. Berman, M.D.
Chairman and CEO
Tufts Health Plan
Waltham, Mass.

Bruce Bradley
Director of Managed Care Plans
General Motors
Detroit, Mich.

Carolyn Clancy, M.D.
Acting Director
Agency for Healthcare Research and Quality
Rockville, Md.

William E. Golden, M.D.
Past President
American Health Quality Association
Washington, D.C.

Lisa I. Iezzoni, M.D.
Professor of Medicine
Harvard Medical School
Boston, Mass.

Kay Coles James
Director
Office of Personnel Management
Washington, D.C.

Mary B. Kennedy
State Medicaid Director
Minnesota Department of Human Services
St. Paul, Minn.

Kenneth W. Kizer, M.D., M.P.H.
President and CEO
National Quality Forum
Washington, D.C.

Norma M. Lang, Ph.D., R.N.
Lillian S. Brunner Professor of Medical Surgical Nursing
University of Pennsylvania
Philadelphia, Pa.

Brian W. Lindberg
Executive Director
Consumer Coalition for Quality Healthcare
Washington, D.C.

Debra L. Ness
Executive Vice President
National Partnership for Women & Families
Washington, D.C.

Paul H. O'Neill
Secretary
U.S. Treasury
Washington, D.C.

Christopher Queram
CEO
Employer Healthcare Cooperative
Madison, Wis.

John C. Rother
Director for Legislation and Public Policy
AARP
Washington, D.C.

Thomas A. Scully
Administrator
Centers for Medicare & Medicaid
Baltimore, Md.

Gerald M. Shea
Assistant to the President for Government Affairs
AFL-CIO
Washington, D.C.

Janet Sullivan, M.D.
Chief Medical Officer
HealthSource/Hudson Health Plan
Tarrytown, N.Y.

James W. Varnum
President
Dartmouth-Hitchcock Alliance
Lebanon, N.H.

Marina L. Weiss
Senior Vice President for Public Policy and Government Affairs
March of Dimes
Washington, D.C.

Liaison Members

Yank D. Coble, Jr., M.D.
President
Physician Consortium for Performance Improvement
American Medical Association
Chicago, Ill.

Janet M. Corrigan, Ph.D.
Division Director
Institute of Medicine, National Academy of Sciences
Washington, D.C.

David J. Lansky, Ph.D.
President
Foundation for Accountability
Portland, Ore.

Margaret E. O'Kane
President
National Committee for Quality Assurance
Washington, D.C.

Dennis S. O'Leary, M.D.
President
Joint Commission for Accreditation of Healthcare Organizations
Oakbrook Terrace, Ill.

Elias A. Zerhouni, M.D.
Director
National Institutes of Health
Bethesda, Md.


Appendix 3

(Current as of the time of the grant; provided by the grantee organization; not verified by RWJF.)

Serious Reportable Events Steering Committee and Advisory Panel

John M. Colmers (Co-Chair)
Program Officer
Milbank Memorial Fund
New York, N.Y.

Lucian L. Leape, M.D. (Co-Chair)
Adjunct Professor
Harvard School of Public Health
Boston, Mass.

Becky Cherney
President and CEO
Central Florida Health Care Coalition
Orlando, Fla.

Robert M. Crane
Senior Vice President and Director
Kaiser Permanente Institute for Health Policy
Oakland, Calif.

David M. Gaba, M.D.
Director
Patient Safety Center of Inquiry
VA Palo Alto Health Care System
Palo Alto, Calif.

Mark Gibson
Policy Advisor to the Governor of Oregon
Salem, Ore.

Sr. Mary Jean Ryan, F.S.M.
President and CEO
SSM Healthcare
St. Louis, Mo.

Paul M. Schyve, M.D.
Sr. Vice President for Government Affairs
JCAHO
Oakbrook Terrace, Ill.

Gerald M. Shea
Assistant to the President for Government Affairs
AFL-CIO
Washington, D.C.

Drew Smith, J.D.
Senior Policy Advisor
AARP Public Policy Institute
Washington, D.C.

Capt. Francis Stewart, M.D., U.S.N.
Program Director for Patient Advocacy and Medical Ethics
Department of Defense
Falls Church, Va.

Renee Turner-Bailey
Executive Director of Healthcare Quality Consortium
Ford Motor Company
Dearborn, Mich.

Liaison Members

Judy Goldfarb, M.A., R.N.
Nurse Consultant
Office of Clinical Standards and Quality
Centers for Medicare & Medicaid Services
Baltimore, Md.

Nancy Foster
Coordinator for Quality Activities
Agency for Healthcare Research and Quality
Rockville, Md.

Daniel M. Fox, Ph.D.
President
Milbank Memorial Fund
New York, N.Y.

Brent C. James, M.D., M.Stat.
Executive Director
Institute for Health Care Delivery Research
Intermountain Health Care
Salt Lake City, Utah

Ex Officio Special Advisory Panel

Cathy A. Blake
Assistant Director
New York State Department of Health
New York, N.Y.

Mary E. Kramer
President
Iowa Senate
Des Moines, Iowa

Jan Malcolm
Commissioner
Minnesota Department of Health
St. Paul, Minn.

Angela Z. Monson
Vice Chair, Health Committee
Oklahoma Senate
Oklahoma City, Okla.

Robert Muscalus, D.O.
Physician General
Pennsylvania Department of Health
Harrisburg, Pa.

Sandy Praeger
Chair
Financial Institutions and Insurance Committee
Kansas Senate
Lawrence, Kan.


Appendix 4

(Current as of the time of the grant; provided by the grantee organization; not verified by RWJF.)

Strategic Framework Board Members

Sheila Leatherman (Co-chair)
Adjunct Professor
University of North Carolina School of Public Health
Chapel, Hill, N.C.

Helen L. Smits, M.D. (Co-chair)
Visiting Scholar
New York University
New York, N.Y.

Donald M. Berwick, M.D., M.P.P.
President and CEO
Institute for Healthcare Improvement
Boston, Mass.

Christine K. Cassel, M.D.
Dean
Oregon Health and Science University
Portland, Ore.

Molly Coye, M.D., M.P.H.
President and CEO
The Health Technology Center
Menlo Park, Calif.

Robert S. Galvin, M.D.
Director, Global Healthcare
General Electric
Fairfield, Conn.

Judith H. Hibbard, Dr. P.H.
Professor
University of Oregon
Eugene, Ore.

Brent C. James, M.D., M.Stat.
Vice President, Medical Research and Continuing Education
Intermountain Health Care
Salt Lake City, Utah

Elizabeth A. McGlynn, Ph.D.
Director
Center for Research on Quality in Healthcare
RAND
Santa Monica, Calif.


Appendix 5

(Current as of the time of the grant; provided by the grantee organization; not verified by RWJF.)

Diabetes Measures Review Committee

Gerald M. Shea (Chair)
Assistant to the President for Government Affairs
AFL-CIO
Washington, D.C.

Yank Coble, M.D.
President
American Medical Association
Chicago, Ill.

Richard Kahn, Ph.D.
Chief Scientific and Medical Officer
American Diabetes Association
Alexandria, Va.

Jeffrey L. Kang, M.D., M.P.H.
Chief Clinical Officer
Centers for Medicare & Medicaid Services
Baltimore, Md.

Marie McBee, M.S.N.
Vice President for Federal Programs
Delmarva Foundation for Medical Care
Easton, Md.

Margaret E. O'Kane
President
National Committee for Quality Assurance
Washington, D.C.

Dennis O'Leary, M.D.
President
Joint Commission on Accreditation of Healthcare Organizations
Oakbrook Terrace, Ill.


Appendix 6

(Current as of the time of the grant; provided by the grantee organization; not verified by RWJF.)

Hospital Care Performance Measures Steering Committee and Working Groups

Steering Committee

Cary Sennett, M.D., Ph.D. (Co-Chair)
American College of Cardiology
Bethesda, Md.

Mary Wakefield, R.N., Ph.D. (Co-Chair)
University of North Dakota
Grand Forks, N.D.

Stuart Baker, M.D.
VHA
Irving, Texas

Diane L. Bechel
Ford Motor Company
Dearborn, Mich.

Robert M. Dickler
Association of American Medical Colleges
Washington, D.C.

Joyce Dubow
AARP
Washington, D.C.

Mary Foley, M.S., R.N.
American Nurses Association
Washington, D.C.

Vanessa N. Gamble, M.D., Ph.D.
Association of American Medical Colleges
Washington, D.C.

William E. Golden, M.D.
American Health Quality Association
University of Arkansas Medical Sciences
Little Rock, Ark.

Brian W. Lindberg, M.M.H.S.
Consumer Coalition for Quality Health Care
Washington, D.C.

Jerod M. Loeb, Ph.D.
Joint Commission on Accreditation of Healthcare Organizations
Oakbrook Terrace, Ill.

John R. Lumpkin, M.D., M.P.H.
Illinois Department of Public Health
Springfield, Ill.

Donald Nielsen, M.D.
American Hospital Association
Chicago, Ill.

Jonathan Perlin, M.D., Ph.D., M.S.H.A.
U.S. Veterans Health Administration
Washington, D.C.

Louise Probst
Gateway Purchasers Coalition for Healthcare
St. Louis, Mo.

Blair L. Sadler, J.D.
Children's Hospital and Health Center
San Diego, Calif.

Marina L. Weiss, Ph.D.
March of Dimes
Washington, D.C.

Steven B. Clauser, Ph.D. — Liaison Member
Centers for Medicare & Medicaid Services
Baltimore, Md.

Irene Fraser, Ph.D. — Liaison Member
Agency for Healthcare Research and Quality
Rockville, Md.

Beth Kosiak, Ph.D. — Liaison Member
Centers for Medicare & Medicaid Services
Baltimore, Md.

Gregg Meyer, M.D., M.Sc.
Agency for Healthcare Research and Quality
Rockville, Md.

Barbara Paul, M.D.
Centers for Medicare & Medicaid Services
Baltimore, Md.

Priorities and Scope Working Group

Stuart Baker, M.D. (Chair)
VHA
Irving, Texas

Ronald R. Blanck, D.O.
American Osteopathic Association
University of North Texas Health Science Center
Fort Worth, Texas College of Osteopathic Medicine
Fort Worth, Texas

Mary Foley, M.S., R.N.
American Nurses Association
Washington, D.C.

William E. Golden, M.D.
American Health Quality Association
University of Arkansas Medical Sciences
Little Rock, Ark.

Jerod M. Loeb, Ph.D.
Joint Commission on Accreditation of Healthcare Organizations
Oakbrook Terrace, Ill.

Arnold Milstein, M.D.
Pacific Business Group on Health
San Francisco, Calif.

Donald Nielsen, M.D.
American Hospital Association
Chicago, Ill.

Irwin Press, Ph.D.
Press, Ganey Associates
South Bend, Ind.

Steven B. Clauser, M.D. — Liaison Member
Centers for Medicare & Medicaid
Baltimore, Md.

Implementation and Improvement Working Group

Cary Sennett, M.D., Ph.D. (Chair)
American College of Cardiology
Bethesda, Md.

Dawn M. FitzGerald, M.S.
Mid-South Foundation for Medical Care
Memphis, Tenn.

Judy Levy, R.N., C.P.H.Q.
Tufts Health Plan
Watertown, Mass.

Samuel Nussbaum, M.D.
Anthem
Indianapolis, Ind.

Gregg A. Pane, M.D., M.P.A.
Veterans Health Administration
Washington, D.C.

Louise Probst
Gateway Purchasers Coalition for Health
St. Louis, Mo.

Bernard Rosof, M.D.
North Shore Long Island Jewish Health System
Great Neck, N.Y.

Shelly Voelz, R.N., B.S.N
St. Francis Hospital and Health Centers
Beech Grove, Ind.

Gregg Meyer, M.D. — Liaison Member
Agency for Healthcare Research and Quality
Rockville, Md.

Reporting Working Group

Diane L. Bechel, Dr. P.H. (Chair)
Ford Motor Company
Dearborn, Mich.

Jennifer Eames
California HealthCare Foundation
Oakland, Calif.

Gina Rocha, R.N., M.P.H.
Rhode Island Department of Health
Providence, R.I.

Ellen Severoni, R.N.
California Health Decisions
Orange, Calif.

Ted von Glahn
Pacific Business Group on Health
San Francisco, Calif.

Marina L. Weiss, Ph.D.
March of Dimes
Washington, D.C.

Robert Weiser
Medical Review of North Carolina
Cary, N.C.


Appendix 7

(Current as of the time of the grant; provided by the grantee organization; not verified by RWJF.)

Safe Practices for Better Health Care Steering Committee and Advisory Group

Maureen Bisognano (Co-Chair)
Institute for Healthcare Improvement
Boston, Mass.

Henri R. Manasse, Jr., Ph.D., Sc.D. (Co-Chair)
American Society of Health System Pharmacists
Bethesda, Md.

Carl Armstrong, M.D.
American Hospital Association
Richmond, Va.

James P. Bagian, M.D., P.E.
U.S. Veterans Health Administration
Ann Arbor, Mich.

David W. Bates, M.D.
Brigham and Women's Hospital
Boston, Mass.

Bruce E. Bradley
General Motors Corporation
Detroit, Mich.

Michael R. Cohen, R.Ph., M.S., D.Sc.
Institute for Safe Medication Practice
Huntingdon Valley, Pa.

Gregg Lehmann, Ph.D.
National Business Coalition on Health
Washington, D.C.

Trudy Lieberman
Consumers Union
Yonkers, N.Y.

Joanne Turnbull, Ph.D.
National Patient Safety Foundation
Chicago, Ill.

Anne Wojner, R.N., M.S.N., Ph.D.
Health Outcomes Institute
Woodlands, Texas

Stephen F. Jencks, M.D., Ph.D. — Liaison Member
Centers for Medicare & Medicaid Services
Baltimore, Md.

Gregg Meyer, M.D., M.Sc. — Liaison Member
Agency for Healthcare Research and Quality
Rockville, Md.

Advisory Panel on Dissemination and Implementation

Maureen Bisognano (Chair)
Institute for Healthcare Improvement
Boston, Mass.

Diane Cousins, R.Ph.
US Pharmacopeia
Rockville, Md.

Suzanne Delbanco, Ph.D.
Leapfrog Group
Washington, D.C.

Lillee S. Gelinas, R.N., M.S.N.
VHA
Irving, Texas

Mary MacDonald
American Federation of Teachers
Washington, D.C.

Ann Monroe
California HealthCare Foundation
Oakland, Calif.

Jo Ellen Ross, M.N.A.
CMRI
San Francisco, Calif.

David Swankin
Citizens Advisory Center
Washington, D.C.

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Articles

Kizer KW. "The National Quality Forum Seeks to Improve Health Care." Academic Medicine, 75(4): 320–321, 2000.

Kizer KW. "The National Quality Forum." Disease Management and Clinical Outcomes, Summer: 70–73, 2001.

Kizer KW. "Quality Improvement Should Be Healthcare's Essential Business Strategy." Frontiers of Health Services Management, 18(1): 47–50, 2001.

Kizer KW. "Establishing Health Care Performance Standards in an Era of Consumerism." Journal of the American Medical Association, 286(10): 1213–1217, 2001. Abstract available online.

Kizer KW. "A Call for a National Summit on Information Management and Healthcare Quality." In Medscape General Medicine, March 13, 2001, www.medscape.com.

Kizer KW. "Patient Safety: A Call to Action: A Consensus Statement from the National Quality Forum." In Medscape General Medicine, March 21, 2001, www.medscape.com.

Kizer KW. "The Emerging Imperative for Health Care Quality Improvement." Academic Emergency Medicine, 9(11): 1078–1084, 2002. Abstract available online.

Kizer KW. "Patient-Centered Care: Essential But Probably Not Sufficient." Quality and Safety in Health Care, 11(2): 117–118, 2002. Abstract available online.

The National Quality Forum Strategic Framework Board. "Design for a National Quality Measurement and Reporting System." Medical Care, 41(1 Suppl.): I1–I89, 2003.

Reports

A Comprehensive Framework for Hospital Care Performance Evaluation. Washington: National Quality Forum, 2003.

Information Technology and Healthcare Quality. Washington: National Quality Forum, 2003.

A National Framework for Health Care Quality Measurement and Reporting. Washington: National Quality Forum, 2002.

National Voluntary Consensus Standards for Adult Diabetes Care. Washington: National Quality Forum, 2002.

National Voluntary Consensus Standards for Hospital Care: An Initial Performance Measure Set. Washington: National Quality Forum, 2003.

Safe Practices for Better Healthcare. Washington: National Quality Forum, 2002.

Serious Reportable Events in Healthcare. Washington: National Quality Forum, 2002.

World Wide Web Sites

www.qualityforum.org. The forum's Web site includes information on its history and mission, activities and consensus reports, and member news. Washington: National Quality Forum, 2000.

Sponsored Workshops

"Reaching the Tipping Point: Measuring and Reporting Quality Using the NQF-Endorsed Hospital Care Measures — A National Summit," February 12–14, 2003, Queenstown, Md. Attended by 70 policy-makers, consumer advocates, health care purchasers, and administrative, operational, and clinical leaders from hospitals and health care systems in California, Tennessee, New York and Wisconsin. Proceedings available online.

"National Summit on Information Technology and Healthcare Quality," March 6–7, 2002, Washington. Attended by 50 national leaders in health care quality and information technology. Proceedings available online. Funded by multiple organizations and co-convened with the Institute of Medicine.

"Improving Healthcare Quality for Minority Populations," June 28–29, 2001, Arlington, Va. Attended by 21 representatives from federal agencies, health plans, school of public health, medical schools, foundations, minority organizations and human service organizations. Proceedings available online. Funded by the Commonwealth Fund.

Presentations and Testimony

Kenneth Kizer, "Reducing Medical Errors and Improving Patient Safety in American Healthcare," testimony before the House Committee on Commerce, Subcommittee on Health and Environment and Subcommittee on Oversight and Investigations and House Committee on Veterans' Affairs, Subcommittee on Health, February 9, 2000.

Kenneth Kizer, "Reducing Therapeutic Adverse Events in U.S. Healthcare," testimony before the House Ways and Means Committee, Subcommittee on Health, February 10, 2000.

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Report prepared by: Karen Gillespie
Reviewed by: Kelsey Menehan
Reviewed by: Molly McKaughan
Program Officer: David Colby

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