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Comment Letter to the NQF on the Recommendations of its Strategic Framework Board

January 17, 2002

Kenneth W. Kizer, MD, MPH
President and CEO
National Quality Forum
601 Thirteenth Street, NW
Suite 500 North
Washington, DC 20005

Dear Ken:

Thank you for the opportunity for the Association of American Medical Colleges to comment as a member of the National Quality Forum on the draft recommendations of the Strategic Framework Board. Consistent with your request, these comments are limited to specific text improvements rather than to tone, themes, or philosophy.

The Recommendations are comprehensive and ambitious. To be effective they must be as explicit as possible and use terms that have meaning to the broadest possible audience. The use of jargon or phrases that have different meanings for different audiences is best avoided if this is to have influence in circles wider than the NQF. Specifically, I believe the quality improvement community must try to communicate to the broadest possible public. That drives the gist of my comments. In that spirit, there follows several recommendations that I hope the SFB will consider.

1. Throughout the document and attachment, and specifically in Recommendation #1, there are references to the "six aims for the health care system proposed by the IOM." It would be effective if the six aims were described by a footnote for readers who are not members of the cognoscenti.

2. Recommendation #2 calls for a set of measures that are "...continually improved based on feedback…." The AAMC suggests that this has the potential for continually moving the target, creating need for further investment in data collection, interpretation, etc. as the process changes. I am not sure how to accommodate this. Perhaps there is a way to hold the target steady for a defined time after which further implementation could be advanced based on an improvement cycle.

3. I believe the essence of Recommendation #7 is embodied in part b and suggest deletion of part a.

4. Recommendation #12 is imprecise. It is not clear to me how boards would incorporate principles of CQI as a condition of certification and recertification. Consider more explicit language such as "incorporate principles in the assessment" or "incorporate assessment of knowledge and skills basic to quality improvement in the certification…"

5. The language in Recommendation #16 e strikes me as imprecise jargon. Patient centered care means different things to different people. "Actualization of the notion of patient centered care" presumably refers to the concept of patient centered care embodied in Crossing the Quality Chasm. If it does, I recommend making this reference explicit. And I am unclear how one "actualizes" a "notion."

I would like to express my appreciation to you, the National Quality Forum, and the Strategic Framework Board for all your difficult work. The AAMC agrees that the very highest goals must be established. Implementation of a fully electronic record, development of the resources to devote to monitoring outcomes, and the concurrence by all insurers and government payers for a parsimonious set of measures are indeed worthy goals. I support them. In that spirit, I certainly appreciate the opportunity to comment on the Strategic Framework Board's Summary document.

Sincerely yours,

Jordan J. Cohen, MD
President