Healthcare Quality Measures

Introduction

Quality measures are used to assess and compare an organization’s healthcare quality. These measures are classified as the outcome, process, or structural (Porter, Larsson, & Lee, 2016). Structural measures offer consumers a view of the capacity, procedures, and systems of the healthcare provider in providing care that is of a higher quality. Examples of fundamental processes are where a provider utilizes medication orders or medical records systems, the provider-to-patient ratio, and the proportion of physicians that are board certified. Process measures show how a healthcare provider improves or maintains health for sick and healthy patients. Examples of process measures include the percentage of recipients of preventive services such as immunizations and mammograms and the percentage of diabetes patients that have blood sugar tests and control measures taken. Process measures enlighten consumers on expected medical care for diseases or particular conditions and can improve recipients’ health outcomes. Outcome measures reflect the healthcare services’ impact on the patient’s status. Examples of outcome measures include the mortality rate of patients following a particular surgical procedure and the rate of hospital-acquired infections or surgical complications (Porter et al., 2016). Accordingly, two quality measures are process measures and outcome measures.

Process measures

Process measures are those that are utilized in determining the extent to which healthcare providers give patients services that are specific and in line with the care guidelines that are recommended (Boyce, Browne, & Greenhalgh, 2014). Process measures are related to treatment or procedures that improve the patient’s health status or prevention of future health conditions or complications. Most often, assessing whether a patient meets the process measures’ requirements is straightforward: Was the recommended care received by the patient or not? Further, process measures enable providers to get actionable and clear feedback, as well as straightforward ways for performance improvement (Boyce et al., 2014). Examples of process measures are such as routine examination by nurse practitioners of diabetic patients’ feet for any occurrence of wounds, whether or not appropriate drugs are prescribed by the physicians to the diabetic patients, and care instructions for certain conditions provided upon discharging a patient from the hospital.

Evaluation of process measures

Challenges

It is problematic to over-rely on process measures for administering provider incentives and also for tracking performance. This is because process measures are lacking in many critical healthcare areas, such as whether a patient is provided with appropriate care or whether coordinated treatment by the physician is provided for patients with mental or physical illnesses (Boyce et al., 2014). Also, the majority of process measures focus mainly on preventive care as well as chronic condition management. This focus may be a distraction from other quality areas that are highly important and more difficult to measure. Such areas where process measurements are challenging to accomplish include organizational culture and teamwork.

Considerations

Process measurements must be designed well to avoid mediocre service but ensure that recommended care is provided (Porter et al.,2016). While these processes reflect mainly on professional care standards, they most times fail to predict outcomes. Hence, it is paramount that process measures be backed with evidence that can reliably link a process to improved outcomes. Most process measures focus mainly on chronic disease prevention and management and are yet lacking in critical areas of healthcare which may impact issues such as technology and care coordination. The development of future process measures ought to focus on these latter areas.

Outcome measures

Outcome measures involve the evaluation of the health of patients after receiving care. These measures focus on the intended or unintended effects of specific patient care on their health, function, and health status (Nelson, Eftimovska,  & Lind et al., 2015). Outcome measures also assess whether or not the accomplishment of goals of care have been achieved. These are the real test of the quality of health care as patients are more interested in overcoming an illness as opposed to the clinical processes that contribute to the final health outcome. Outcome measures often involve survival measures (mortality), disease incidence (morbidity), and health-related issues on quality of life. Although information reported by patients is included in outcome measures, they fail to fully assess the experience of the patient (Nelson et al., 2015).

Though outcome measures are critical to both providers and patients, there is a limit to their usefulness, as it is challenging to develop meaningful outcome measures. Some examples of outcome measures are assessing the rate of amputation for diabetic patients; the rate of remission in cancer patients; pain relief quality in hip replacement patients; the percentage of patients with postoperative complications or infections; and in-hospital patient fall rates and subsequent injury.

Evaluation of outcome measures

Challenges

Outcome measures often call for information that is detailed which is available in medical records only. This information is not only difficult to obtain, but it is also costly to access it. It is also challenging to gather sufficient data that can offer useful information on a specific outcome (Nelson et al., 2015). Although there are factors that can profoundly impact health outcomes, such as social determinants of health (for example, economic opportunity, social support, and safe housing), there are differences in opinion on providers’ responsibility for the social determinants’ confounding effects. Also, diversity in patient populations can further complicate the achievement of specific outcomes (Nelson et al., 2015). An example of such complications is when it becomes difficult to ensure that a given percentage of diabetic patients attended by a physician have controlled blood sugar levels, which could be difficult if such a provider has sicker patients or have several co-occurring chronic conditions.

Considerations

Because outcome measures reflect what is of importance to patients, it becomes critical that when developing them, the preferences, values, and needs of the patient be prioritized. During the development, evaluation, and use of outcome measures, it is critical that the potential impact of social determinants of health be recognized in addition to the diversities in patient populations (Anhang, Elliott, Zaslavsky, et al., 2014). This is important as patients utilize outcome measures in deciding which healthcare services or providers to engage with especially if the information also highlights on costs of services.

Conclusion

Hospital care quality has expanded reporting and measuring initiatives in recent years. There is a rapid evolution of the current sets of hospital measurements geared at meeting the need of consumers for information regarding the effectiveness of clinical services, patient safety, health outcomes, and care-centered patient experiences (Porter et al., 2016). Improvement of healthcare through the utilization of quality measures can be achieved by establishing strategies that set priorities and providing a plan to ensure the achievement of goals. These goals include affordable care, improved care, and communities and people that are healthier. Stakeholders in the healthcare industry ought to develop a set of priorities (Porter et al., 2016). These priorities include ensuring safer care by reducing the harm caused when delivering care; promoting treatment and prevention practices that are most effective for conditions attributed to high mortality rates. Also, ensuring individuals, as well as their family members, are actively involved in their care, promoting healthy living through the engagement of communities; and ensuring quality care is made affordable for all persons through effective healthcare models.

References

Anhang Price, R., Elliott, M. N., Zaslavsky, A. M., Hays, R. D., Lehrman, W. G., Rybowski, L., … & Cleary, P. D. (2014). Examining the role of patient experience surveys in measuring health care quality. Medical Care Research and Review, 71(5), 522-554.

Boyce, M. B., Browne, J. P., & Greenhalgh, J. (2014). The experiences of professionals with using information from patient-reported outcome measures to improve the quality of healthcare: a systematic review of qualitative research. BMJ Qual Saf, bmjqs-2013.

Nelson, E. C., Eftimovska, E., Lind, C., Hager, A., Wasson, J. H., & Lindblad, S. (2015). Patient reported outcome measures in practice. Bmj, 350, g7818.

Porter, M. E., Larsson, S., & Lee, T. H. (2016). Standardizing patient outcomes measurement. New England Journal of Medicine, 374(6), 504-506.

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Healthcare Quality Measures

Assignment Details

Unit outcome(s) addressed in this Assignment:

• Discuss methods for evaluating quality of services in healthcare settings.
• Explain importance of measuring business performance and quality.
• Use basic tools for measuring business performance and quality.

Course outcome(s) addressed in this Assignment:

• HA499-5: Healthcare Administration: Demonstrate an understanding of the forces impacting health delivery systems and the effective and efficient management of healthcare.

Instructions:

For this Assignment, you are required to write a 1,000–1,250-word paper on methods of quality measurement. Your paper must include a detailed summary of two different methods of quality measurement used by a healthcare organization. Include examples of how the methods may be used to improve organizational effectiveness. Give an evaluation of these methods and indicate when they should be used for best results. Cite at least four references to validate your proposal. Prepare this Assignment according to the APA guidelines.

Submitting your work:

• Submit your Assignment to the appropriate Dropbox.

To view your graded work, come back to the Dropbox or go to the Gradebook after your instructor has evaluated it. Make sure that you save a copy of your submitted work.