How do you measure quality improvement in healthcare?
"The Agency for Healthcare Research and Quality (AHRQ) has outlined the three types of quality measures using the Donabedian classification model 1. Measures are classified as structure, process or outcome measures. Show
Structure measures: Structural measures are the health care provider’s overall ability to provide high quality care: the institution’s capacity, systems and processes. These measures may include whether the organization uses more modern electronic medical records and medication order entry systems. Measures could also include how many board-certified physicians are on staff or the ratio of providers to patients. Process measures: Process measures are what the institution does to maintain or improve health. These measures can reflect both preventative measures or those already experiencing health issues. These measures should evaluate how the institution is meeting generally accepted standards of practice. Most health care quality measures in public reporting are process measures. Outcome Measures: Outcome measures reflect the impact the institution’s patient interventions and how they improved the health of patients. Examples of outcome measures include rates for surgical mortality, patient readmission, surgical complications and hospital-acquired infections. Though a focus on quality measures and quality assurance has the potential to help improve healthcare, some healthcare professionals 2 have warned that there's only limited evidence that many quality measures or performance measures result in improved health outcomes —including those tied to incentives by
insurers or governments. Despite this limitation, quality measures and comparative quality ratings continue to increase in popularity because the measures are based on intermediate endpoints, such as risk-factor control or care processes that are vulnerable to gaming, over-testing and over-treatment. Instead, quality measures should be based on patient-centered outcomes with individualized approaches to clinical complexity. Quality Measures: Why Use Them?Measures
inform us about how the health care system is performing. Measures help identify weaknesses, prioritize opportunities, and can be used to identify what works and doesn’t work to drive improvement. Measures can also prevent the overuse, underuse, and misuse of health care services and can identify disparities in care delivery and outcomes. Measures are used for quality improvement, benchmarking, and accountability. Measures are becoming increasingly important relative to payment as the U.S.
health care system shifts away from traditional fee-for-service toward payment focused on the value of care. Types of Quality MeasuresThe table below defines and provides examples of some common measure types.
Choosing Quality Measures: How to Determine What to MeasureChoose measures that:
Core Quality Measures CollaborativeThe Collaborative is a public and private, multi-stakeholder effort working to define core measure sets for various specialties. With significant input from the AAFP, the Collaborative developed an Accountable Care Organizations and Patient Centered Medical Home/Primary Care Core Measure Set for primary care. This effort exists to:
Access a full list of all the specialty core measure sets» Components of a Quality MeasureA measure has several parts, including:
What Makes a Good Quality Measure?The NQF measure evaluation criteria align with criteria established by the AAFP. These include:
Additionally, measures should be evaluated for:
How are Quality Measures Developed?Quality measures are typically developed based on evidence generated through research and clinical practice, with most measures beginning as clinical guidelines. Developers of measures include:
The organization that develops and is responsible for updating and maintaining a measure is called a measure steward. The process of measure development is lengthy and
expensive, and requires review of evidence, analysis of care gaps, feasibility assessment, determination of data sources, development of detailed specifications, and field testing. How are Quality Measures Endorsed?The NQF is a nonprofit, nonpartisan, membership-based organization which brings together public and private-sector organizations to reach consensus on how to measure quality in health care. NQF does not develop measures, but instead reviews, endorses, and recommends use of measures for various programs. NQF endorsement is voluntary, but endorsed measures are favored for use in federal and private-sector programs because of the rigorous process followed for endorsement. The NQF uses a Consensus Development Process (CDP) to evaluate and endorse measures. For each topic, expert committees are formed, comprised of patients, physicians, other health professionals,
suppliers, subject matter experts, and payers. The committee evaluates measures submitted by developers, issues a draft report of findings, gathers member and public comment, and votes to reach a consensus on endorsement recommendations. Committee recommendations are sent to the Consensus Standards Approval Committee (CSAC) where a final endorsement decision is made. Working for You: The AAFP’s Role in Quality Measure Development and EndorsementThe AAFP does not
itself develop measures, but advises developers and stakeholders to ensure the voice of family medicine is heard. The AAFP nominates its members as representatives to external workgroups that develop and endorse measures and responds during measure comment periods. The AAFP is represented on the NQF Measures Application Partnerships (MAP), which makes recommendations to CMS regarding measures that should be adopted for use in various payment and recognition programs, such as MIPS, Alternative
Payment Models (APMs), Medicaid, and others. What are the 3 types of measures for quality improvement?Three Types of Measures
Use a balanced set of measures for all improvement efforts: outcomes measures, process measures, and balancing measures.
How is quality of healthcare measured?Principles for measuring the quality of health care
Measure aspects of care that go beyond technical quality, e.g. responsiveness, acceptability and trust. Measure perceived quality and compare with clinical quality. Measure quality at different points in the patient pathway through the health system.
What are the five key measurements of quality improvement?Every successful quality improvement program is based on the five key components.. The problem,. The goal,. The aim,. The measures, and.. The Analytics.. What is an example of a quality measure in healthcare?Examples include: Number of beds and the types of services available. Whether the hospital is accredited or has other types of specialty certification. The use of electronic patient medical records or prescription ordering systems.
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