Creating a health care system that meets patient needs:
The Institute of Medicine’s Six Aims to Improve Care

How does a nation improve health care? Policymakers and health care professionals from across the U.S. have posed this question. Many experts believe the answer lies in six aims outlined in the Institute of Medicine’s (IOM) 2001 report “Crossing the Quality Chasm.” This report challenges health care professionals to provide care that is effective, patient-centered, timely, efficient, equitable and safe. According to the IOM, these areas can have a dramatic impact on a patient’s outcome.

AFMC and Quality Improvement Organizations across the U.S. have committed to these aims, as evidenced throughout our quality improvement performance measures.

1. Safe: Avoiding injuries from care that is intended to help.
2. Timely: Reducing waits and delays for those who receive care.
3. Effective: Providing services to all who could benefit from them, and refraining from providing services to those who would not.
4. Efficient: Avoiding waste, including waste of equipment, supplies, ideas and energy.
5. Equitable: Providing care that does not vary in quality due to the patient’s gender, ethnicity, geographic location or socioeconomic status.
6. Patient-Centered: Providing care that is respectful of individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions.

1. Safe

Performance Measures	Payer	Setting	Data Source
Drugs to be avoided in the elderly	Medicare/Medicaid	Outpatient	HEDIS
High-risk pressure ulcers	Medicare/Medicaid	Nursing Home	MDS
Physical restraints	Medicare/Medicaid	Nursing Home	MDS
Improvement in management of oral medication	Medicare	Home Health	OASIS

2. Timely

Performance Measures	Payer	Setting	Data Source
First antibiotic within four hours — Pneumonia	All	Hospital	QIO Clinical Warehouse
Pneumococcal vaccination given/screened — Pneumonia	All	Hospital	QIO Clinical Warehouse
Influenza vaccination given/screened — Pneumonia	All	Hospital	QIO Clinical Warehouse
Oxygenation assessment within 24 hours — Pneumonia	All	Hospital	QIO Clinical Warehouse
Blood cultures performed within 24 hours — Pneumonia	All	Hospital	QIO Clinical Warehouse
Getting care without long waits	Medicaid	Outpatient	CAHPS
Follow-up care for children prescribed ADHD medication	Medicaid	Outpatient	HEDIS
Phone call with provider	Medicaid	Outpatient	CAHPS
Doctor communicated well and spent enough time with the patient	Medicaid	Outpatient	CAHPS
PCI received within 90 minutes of hospital arrival — AMI	All	Hospital	QIO Clinical Warehouse
Fibrinolytic Therapy received within 30 minutes of hospital arrival — AMI	All	Hospital	QIO Clinical Warehouse
Prophylactic antibiotics discontinued within 24 hours of surgery end time — Surgical	All	Hospital	QIO Clinical Warehouse
Cardiac surgery patients with controlled 6 a.m. postoperative serum glucose — Surgical	All	Hospital	QIO Clinical Warehouse
Antibiotic received within one hour before incision or within two hours if vancomycin is used — Surgical	All	Hospital	QIO Clinical Warehouse

3.Effective

Performance Measures	Payer	Setting	Data Source
Beta blocker at arrival — AMI	All	Hospital	QIO Clinical Warehouse
Beta blocker prescribed at discharge — AMI	All	Hospital	QIO Clinical Warehouse
Aspirin at arrival — AMI	All	Hospital	QIO Clinical Warehouse
Aspirin prescribed at discharge — AMI	All	Hospital	QIO Clinical Warehouse
ACEI or ARB for LVSD — AMI and HF	All	Hospital	QIO Clinical Warehouse
Antibiotic selection according to guidelines — Pneumonia	All	Hospital	QIO Clinical Warehouse
Influenza vaccination given/screened — Pneumonia	All	Hospital	QIO Clinical Warehouse
First antibiotic within 4 hours — Pneumonia	All	Hospital	QIO Clinical Warehouse
Pneumococcal vaccination given/screened — Pneumonia	All	Hospital	QIO Clinical Warehouse
Evaluation of LVS function — HF	All	Hospital	QIO Clinical Warehouse
Discharge Instructions — HF	All	Hospital	QIO Clinical Warehouse
Received prophylactic antibiotics consistent with current recommendations — Surgical	All	Hospital	QIO Clinical Warehouse
Cardiac surgery patients with controlled 6 a.m. postoperative serum glucose— Surgical	All	Hospital	QIO Clinical Warehouse
Surgery patients with appropriate hair removal — Surgical	All	Hospital	QIO Clinical Warehouse
Colorectoral surgery patients with immediate postoperative normothermia — Surgical	All	Hospital	QIO Clinical Warehouse
Antibiotic received within one hour before incision or within two hours if vancomycin is used — Surgical	All	Hospital	QIO Clinical Warehouse
Prophylactic antibiotics discontinued within 24 hour of surgery end time — Surgical	All	Hospital	QIO Clinical Warehouse
Use of appropriate medications for people with asthma	Medicaid	Outpatient	HEDIS
Breast cancer screening	Medicaid/ Medicare	Outpatient	HEDIS
Cervical cancer screening	All	Outpatient	HEDIS
Chlamydia screening in women	Medicaid	Outpatient	HEDIS
Comprehensive diabetes care	All	Outpatient	HEDIS
Childhood immunization status	Medicaid	Outpatient	HEDIS
Appropriate treatment for children with upper respiratory infection	Medicaid	Outpatient	HEDIS
Appropriate testing for children with pharyngitis	Medicaid	Outpatient	HEDIS
Drugs to be avoided in the elderly	Medicaid/ Medicare	Outpatient	HEDIS
Doctor gave information concerning blood test for hepatitis B	Medicaid	Outpatient	PRAMS
Doctor gave information concerning blood test for diabetes	Medicaid	Outpatient	PRAMS
Doctor gave information concerning blood test for Rh factor	Medicaid	Outpatient	PRAMS

4. Efficient

Performance Measures	Payer	Setting	Data Sourceh
Improvement in management of oral medication	Medicare/ Medicaid	Home Health	OASIS
Appropriate treatment for children w/upper respiratory infection	Medicaid	Outpatient	HEDIS
Acute care hospitalization	Medicare/ Medicaid	Home Health	OASIS
Blood cultures performed in the emergency dept. prior to initial antibiotic received in hosp. — Pneumonia	All	Hospital	QIO Clinical Warehouse
Antibiotic selection according to guidelines — Pneumonia	All	Hospital	QIO Clinical Warehouse
Prophylactic antibiotics discontinued within 24 hours of surgery end time — Surgical	All	Hospital	QIO Clinical Warehouse
Received prophylactic antibiotic consistent w/current recommendations — Surgical	All	Hospital	QIO Clinical Warehouse

5. Equitable

Performance Measures	Payer	Setting	Data Source
Well-child visits in the first 15 months of life	Medicaid	Outpatient	HEDIS
Well-child visits in the third, fourth, fifth and sixth years of life	All	Outpatient	HEDIS
Adolescent well-care visits	Medicaid	Outpatient	HEDIS
Annual dental visit	Medicaid	Outpatient	HEDIS
Children and adolescents' access to primary care practioners	Medicaid	Outpatient	HEDIS
Ease of finding a personal doctor	Medicaid	Outpatient	CAHPS
Ease of getting a referral to see a specialist	Medicaid	Outpatient	CAHPS
Getting the care you need	Medicaid	Outpatient	CAHPS
Calling their doctor for advice	Medicaid	Outpatient	CAHPS
Getting medical care for regular/routine needs	Medicaid	Outpatient	CAHPS
Getting medical care for illness/injury	Medicaid	Outpatient	CAHPS
Seeing a specialist	Medicaid	Outpatient	CAHPS
Did not change prenatal care provider	Medicaid	Outpatient	PRAMS
Had recommended number of prenatal visits	Medicaid	Outpatient	PRAMS
Traveled less than 30 miles one way to a prenatal care provider	Medicaid	Outpatient	PRAMS
Called their prenatal care provider for advice	Medicaid	Outpatient	PRAMS
Took their child for at least one well-baby check-up	Medicaid	Outpatient	PRAMS
Felt finding a prenatal care provider was "not a problem"	Medicaid	Outpatient	PRAMS
Found calling for advice during regular office hours "not a problem"	Medicaid	Outpatient	PRAMS
Adult access to preventive/ambulatory health services	All	Outpatient	HEDIS

6. Patient Centered

Performance Measures	Payer	Setting	Data Source
Doctor communicated well and spent enough time with the patient	Medicaid	Outpatient	CAHPS
Overall average quality and satisfaction ratings: PCP	Medicaid	Outpatient	CAHPS
Overall average quality and satisfaction ratings: Specialist	Medicaid	Outpatient	CAHPS
Overall average quality and satisfaction ratings: Quality of care	Medicaid	Outpatient	CAHPS
Overall average quality and satisfaction ratings: Medicaid	All	Hospital	CAHPS
Discharge instructions — HF	All	Hospital	QIO Clinical Warehouse
Smoking cessation counseling during hospitalization — AMI, HF, Pneumonia	Medicaid	Hospital	QIO Clinical Warehouse
Advice to quit smoking	Medicaid	Outpatient	CAHPS
Recommended or discussed smoking cessation medications	Medicaid	Outpatient	CAHPS
Recommended or discussed smoking cessation methods or strategies	Medicaid	Outpatient	CAHPS
Office staff treated patient with courtesy and respect	Medicaid	Outpatient	CAHPS
Doctor gave information concerning safe medicines	Medicaid	Outpatient	PRAMS
Doctor gave information concerning diet, exercise and proper nutrition	Medicaid	Outpatient	PRAMS
Doctor gave information concerning the "baby blues"	Medicaid	Outpatient	PRAMS
Doctor gave information concerning using a car seat for your baby	Medicaid	Outpatient	PRAMS
Average quality and satisfaction ratings: Prenatal health care provider	Medicaid	Outpatient	PRAMS
Average quality and satisfaction ratings: Prenatal health care	Medicaid	Outpatient	PRAMS
Average quality and satisfaction ratings: Hospital care	Medicaid	Hospital	PRAMS
Average quality and satisfaction ratings: Courtesy, respect and helpfulness of the medical office staff	Medicaid	Outpatient	PRAMS
How well prenatal care providers communicate	Medicaid	Outpatient	PRAMS
Calling the doctor for advice	Medicaid	Outpatient	CAHPS
Called their prenatal care provider for advice	Medicaid	Outpatient	CAHPS
Chronic care pain	Medicare/ Medicaid	Nursing Home	MDS