In October 2008, the National Quality Forum released important new tools for improving the quality of maternity care: a set of 17 national measures for assessing the quality of care around the time of birth. The page gives background and details.
What is health care performance measurement?
Performance measurement is crucial for those who receive, provide, pay for and set policy about health care – all of us!
Performance measurement means holding up the performance of hospitals and other facilities, health professionals (individuals and groups), health plans, and other responsible individuals and groups to standards of care. How do they measure up?
To measure performance, we need specific “measures” that 1) address priority areas with room for improvement, 2) are based on good science, and 3) work well in the current health system. Measures can address many dimensions of care, including what is done or not done, health outcomes, experience of those receiving care, and access to needed services.
Why is performance measurement a key to quality improvement?
Performance measurement, along with disclosure of the results – often called “transparency” – is an invaluable tool for key groups in the health system:
- Consumers can use performance results to compare and choose among providers, care settings and health plans.
- Purchasers (e.g., employers and Medicaid programs) can use performance results and their buying power to get better care for beneficiaries and better value for their investment.
- Health care providers – including professionals, hospitals and health plans – can use results to improve their performance, increase confidence in their work, demonstrate high performance, and become more competitive in the health care market.
- Policymakers can assess the performance of the health system and identify opportunities for policy intervention.
What is National Quality Forum’s role in performance measurement?
The National Quality Forum (NQF) is a not-for-profit organization that brings people together from across the health system to work on quality improvement. A key focus of NQF is collaboration to identify, evaluate and endorse national standardized performance measures that can be used widely in the United States.
NQF has about 400 member organizations and agencies, each of which joins one of eight NQF Councils. Much NQF work is carried out through the councils: Consumer; Health Plan; Health Professional; Provider Organization; Public/Community Health Agency; Purchaser; Quality Measurement, Research and Improvement; and Supplier/Industry. Childbirth Connection is active in the Consumer Council, and Childbirth Connection’s Executive Director, Maureen Corry, serves as its Vice Chair. Other groups that are involved with maternity care belong to various NQF councils.
What National Quality Forum work is relevant to maternity care?
In 2008, NQF endorsed 17 performance measures for care from the end of pregnancy through discharge from a hospital or birth center. The project also identified gaps in measures and areas where new measures are needed. Childbirth Connection’s Executive Director, Maureen Corry, served as Co-Chair of the Steering Committee that guided this project. NQF has now endorsed a total of 25 performance measures with special relevance to maternity care. Other NQF projects with implications for maternity care include its standards for informed consent, for consumer-focused public reporting of performance results, and for infection control.
What new measures can make a big difference for many mothers and babies?
Of the 17 performance measures that the National Quality Forum recently endorsed, several would – if widely implemented – improve care for a large proportion of childbearing women and newborns:
- Elective Delivery Prior to 39 Completed Weeks Gestation
- Cesarean Rate for Low-Risk First-Birth Women
- Incidence of Episiotomy
- Exclusive Breastfeeding at Hospital Discharge.
Other measures in the set address less common interventions and conditions and thus have potential to improve care for a smaller proportion of women and babies.
What are the next steps in using performance measurement to improve maternity care quality?
More work is needed to ensure that performance measurement results in maternity care quality improvement. Use of the measures is voluntary, and it will be important for those with regulatory or purchasing power (such as states, Medicaid programs and accrediting bodies) to measure performance and publicly report results. Consumers will need access to user-friendly reports and help with interpreting results and using them to choose high quality care. To drive needed quality improvement, purchasers should use results to shape how they pay for and reward high quality maternity care. Feeding results back to maternity health professionals and facilities will help them to improve their care.
Learn about efforts to expand the impact of NQF measures on our Progress page >>
It will also be important to identify and endorse high-quality national performance measures for segments of maternity care that were not included in the 2008 measure set — pregnancy, postpartum care, and coordination of care across the maternity continuum and between maternity care and the rest of the health care system. It will be crucial to fill in important gaps where sound measures do not currently exist, and to monitor and improve the process of maternity performance measurement.
Learn more about performance measurement and leveraging of results in our Blueprint for Action.