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Priority Areas for Improvement of Quality in Public Health

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Priority Areas for Improvement of Quality in Public Health Priority Areas for Improvement of Quality in Public Health U.S. Department of Health and Human Services Office of the Assistant Secretary for Health Public Health Quality Forum November 2010 For more information contact: U.S. Department of Health and Human Services Office of the Assistant Secretary for Health Office of Healthcare Quality 200 Independence Ave, SW, Room 719B Washington, DC 20201 202-260-5184 Suggested Citation Honoré, P.A., & Scott, W. (2010). Priority areas for improvement of quality in public health. Washington, DC: Department of Health and Human Services. Vision for Public Health Quality Howard K. Koh, MD, MPH Assistant Secretary for Health November 6, 2010 Priority Areas for Improvement of Quality in Public Health Improving the health of our nation remains a noble societal goal. Yet, for too long, people across America have not reached their full health potential. We need revitalized efforts to move toward a healthier nation. The advent of the Affordable Care Act serves as a catalyst for such change by promoting quality, access to care, and community and clinical prevention. We should maximize this transformative opportunity to elevate the health of our society. Improving quality lies at the heart of the Affordable Care Act. At this critical time, we should synthesize lessons learned from the seminal work in quality initially established in the healthcare arena and also broaden quality improvement efforts that can apply to populations. This will require commitment and coordination from many sectors of society, an approach requiring “health in all policies”. It will also require a vision that links quality, prevention, treatment and access to care. Public health professionals can help coordinate all these critical efforts. Strengthening the foundations for quality will surely help us fulfill our collective mission of ensuring conditions for a healthy population. As Assistant Secretary for Health, I believe our vision for public health quality is to focus on building better systems to give all people what they need to reach their full potential for health. This report represents a call to action for public health. The priority areas presented here represent important steps toward fulfilling that vision. Together, we can give priority to improving quality in the areas identified, raise quality and transform opportunity into actions that make a difference in the lives of all Americans. /Howard K. Koh/ Howard K. Koh, MD, MPH Acknowledgements The Public Health Quality Forum (PHQF) provided direction for the development of this report. The Assistant Secretary for Health, Howard Koh, serves as chair of the PHQF. The project was led by the Office of Healthcare Quality, Don Wright, Deputy Assistant Secretary for Healthcare Quality. Don Berwick, Administrator, Centers for Medicare and Medicaid Services, provided direction for incorporating concepts for system-level results. Coordination and support was provided by the Office of Minority Health, Garth Graham, Deputy Assistant Secretary for Minority Health. The Office of HIV/AIDS Policy and Office on Women’s Health are also recognized for their support of the project. The PHQF benefited from expertise and presentations made by a panel of experts who informed the process. Authors of the report, Peggy Honoré and Wakina Scott, were supported by consultation from Yale University School of Public Health, several contributors serving as subject experts, and a broad continuum of external reviewers with vested interest and experiences with the public health system. Informants to the entire process are acknowledged below. _______________________________ Public Health Quality Forum Office of the Assistant Secretary for Health, Howard Koh, Chair Administration for Children and Families Administration on Aging Agency for Healthcare Research and Quality Centers for Disease Control and Prevention Centers for Medicare and Medicaid Services Food and Drug Administration Health Resources and Services Administration Indian Health Service National Institutes of Health Substance Abuse and Mental Health Services Administration Office of Healthcare Quality Office of Minority Health Office of the Assistant Secretary for Planning and Evaluation Office of the Assistant Secretary for Preparedness and Response Office of the National Coordinator for Health Information Technology Office of the Surgeon General Office on Disability vii Expert Participants American Public Health Association National Association of County and City Health Officials Association of State and Territorial Health Officials National Association of Local Boards of Health Academy Health Trust for America’s Health _______________________________ Authors Peggy Honoré, Director, Public Health Systems, Finance, and Quality Program, Office of Healthcare Quality and Office of Minority Health, U.S. Department of Health and Human Services, [email protected] Wakina Scott, Public Health System Researcher, Office of Healthcare Quality and Office of Minority Health, U.S. Department of Health and Human Services, [email protected] _______________________________ Consultants Paul Cleary, Dean, School of Public Health, Yale University Linda Degutis, Associate Professor of Emergency Medicine and of Epidemiology, School of Public Health, Yale University _______________________________ Contributors Cheryll Lesneski, Clinical Assistant Professor, Gillings School of Global Public Health, University of North Carolina-Chapel Hill Suzanne Heurtin-Roberts, Health Scientist, Division of Cancer Control and Population Sciences, Behavioral Research Program, National Institutes of Health, U.S. Department of Health and Human Services Patty Mabry, Senior Advisor, Office of Behavioral and Social Sciences Research, National Institutes of Health, U.S. Department of Health and Human Services. Richard Riegelman, Professor of Epidemiology-Biostatistics, Medicine and Health Policy, Founding Dean, School of Public Health and Health Services, The George Washington University viii Reviewers Mark Bertler, Chief Executive Officer, Public Health Foundation Enterprises, Inc. Ron Bialek, Executive Director, Public Health Foundation Arnold Epstein, Chair, Department of Health Policy and Management, School of Public Health, Harvard University Melissa Hansen, Policy Specialist, National Council of State Legislators Jason Hsieh, Senior Policy Analyst, National Governors Association Peter Jacobson, Professor of Health Law and Policy, Director, Center for Law, Ethics, and Health, University of Michigan School of Public Health Walter Jones, Professor, Health Administration and Policy, College of Health Professions, Medical University of South Carolina Karen Minyard, Executive Director, Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University Anna Orlova, Executive Director, Public Health Data Standards Consortium Mary Pittman, President and Chief Executive Officer, Public Health Institute Eileen Salinsky, Independent Consultant James Studnicki, Chair, Health Services Research and Professor, University of North Carolina-Charlotte Abraham Wandersman, Professor, Department of Psychology, University of South Carolina Douglas R. Wholey, Professor, Health Policy and Management, School of Public Health, University of Minnesota _______________________________ Special recognition to the Office of Minority Health Resource Center for graphic design. ix Contents EXECUTIVE SUMMARY ........................................................................................... 1 Coordinated Approach To Quality ...................................................................... 1 Priority Areas ....................................................................................................... 3 Moving Forward .................................................................................................. 6 CHAPTER 1: INTRODUCTION ................................................................................ 11 Project Purpose ............................................................................................. 11 Study Process ................................................................................................. 12 Criteria ........................................................................................................... 13 Framework ..................................................................................................... 13 CHAPTER 2: PRIORITY AREAS FOR IMPROVEMENT OF QUALITY IN PUBLIC HEALTH .......................................................................... 19 Priority Areas as Primary Drivers of Quality .................................................. 19 CHAPTER 3: DESCRIPTION OF PRIORITY AREAS .................................................. 27 Population Health Metrics and Information Technology ................................. 29 Evidence-Based Practices, Research, and Evaluation ....................................... 35 Systems Thinking ............................................................................................... 41 Sustainability and Stewardship ......................................................................... 47 Policy ................................................................................................................. 53 Workforce and Education ................................................................................. 57 Appendix A: Primary and Secondary Drivers of Quality for HAI, HIV and Healtly Weight ........................................................................
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