Domains of Quality: Effectiveness

The Institute of Medicine (IOM) considers effectiveness to be one of the six domains of healthcare quality. The IOM defines effectiveness as providing services based on scientific knowledge and refraining from services not likely to benefit. Effectiveness measures include ratings of clinical performance; for example did your doctor provide you with services recommended for your age group such as pap smears, colorectal screening, mammograms, and vaccinations.

Effectiveness measures also include ratings of how well your doctor managed chronic conditions, such as testing diabetics for glucose and lipid levels, or prescribing controller medications for asthmatics. HEDIS (Health Plan and Employer Data and Information Set) is the best known set of clinical performance measures. HEDIS was developed by NCQA as part of its voluntary accreditation process. HEDIS is standardized to enable HMOs to be compared on healthcare quality performance measures at the state, regional and national level. Additional information on HEDIS is available through NCQA.

Effectiveness measures constitute the bulk of all of the HEDIS measures, which we call Meeting National Standards of Care, that OPA uses in this Report Card. Consequently, we have more information on effectiveness than any other domain of quality.