Logan Reid
Hospitals use a variety of methods to measure the quality of care they provide. These methods are classified as either a structure, process, or outcome measure, known as the Donabedian model. Structural measures give an overview of a hospital's capacity to provide high-quality care, including the use of electronic medical records, the number of board-certified physicians, and the ratio of providers to patients. Process measures indicate the actions taken by healthcare providers to maintain or improve health, such as the percentage of people receiving preventive services like immunizations. Outcome measures reflect the impact of healthcare interventions on patient health, including surgical mortality rates and hospital-acquired infection rates. Clinical records, such as disease registries, and administrative data are also used to assess patterns of care and quality indicators. National organizations, such as the National Quality Forum (NQF), play a crucial role in endorsing quality measures and standards for healthcare providers. These measures help hospitals identify areas for improvement and ensure they meet or exceed national benchmarks for quality healthcare delivery.
| Characteristics | Values |
|---|---|
| Structure | Capacity, systems, and processes to provide high-quality care |
| Process | Actions taken to maintain or improve health |
| Outcome | Impact of healthcare service or intervention on patient health status |
| Patient-centredness | Patient-reported experience measures (PREMs) |
| Effectiveness | Surgery performed within 24 hours of admission |
| Safety | Anticoagulation to prevent thromboembolism |
| Efficiency | Administrative data |
| Timeliness | Data lag issues |
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What You'll Learn
Structural measures
The use of electronic medical records is an important structural measure, as it indicates a hospital's ability to efficiently store and access patient data. This can improve the coordination of care and reduce errors associated with paper-based records. Medication order entry systems are another technological measure, allowing doctors to electronically send and track medication orders, reducing potential errors and improving patient safety.
The number and proportion of board-certified physicians are further structural indicators of quality. Board certification indicates that a physician has passed examinations and met the requirements of a specialist medical board. A higher number of board-certified physicians may suggest a higher standard of care, as these physicians have demonstrated expertise in their field.
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Process measures
One example of a process measure is the percentage of people receiving preventive services. This could include the number of patients who receive mammograms or immunizations, which are essential for maintaining good health and preventing diseases. Process measures can also focus on specific patient groups, such as assessing the quality of care received by patients with hip fractures in hospitals. Effectiveness, safety, and patient-centredness are key aspects in this context. For instance, surgery performed within 24 hours of admission for a hip fracture can be a process indicator of effectiveness, while the use of anticoagulation to prevent thromboembolism can indicate safety. Additionally, offering patients a choice of anaesthesia (spinal or general) demonstrates patient-centred care.
Furthermore, process indicators can be developed based on clinical guidelines or standards of care. For instance, a process indicator for effective care for AMI patients may be whether they are administered aspirin upon arrival. Similarly, a surgery safety checklist can serve as a process indicator to ensure surgical safety. Patient-reported experience measures (PREMs) are also considered in process measures to evaluate patient-centredness.
The development and implementation of process measures should be fit for purpose and carefully executed in collaboration with healthcare providers and clinicians. Clinical data, such as electronic health records, play a crucial role in enabling more detailed process measurements. Process measures are an essential tool for improving healthcare quality and patient outcomes, providing valuable insights into the actions taken by healthcare organizations to enhance patient health.
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Outcome measures
In the context of international comparisons, entire countries may constitute a target of measurement. For instance, the OECD Health Care Quality Indicators project coordinates efforts to develop and report quality measures at the health system level. Effectiveness, safety, responsiveness, accessibility, equity, and efficiency are domains of healthcare quality that are measured or found within quality frameworks of member countries.
Quality measurement initiatives, such as those by the Centers for Medicare and Medicaid Services (CMS), focus on improving healthcare quality through accountability and public disclosure. CMS uses quality measures for quality improvement, pay for reporting, and public reporting. These quality measures assess healthcare processes, outcomes, patient perceptions, and organizational structure to ensure high-quality healthcare.
Additionally, clinical measures are designed to ensure the success of healthcare services and allow for comparisons between hospitals. These measures are based on national benchmarks and empower individuals to make well-informed healthcare decisions. National organizations review and grade hospital quality and safety, providing rankings that help individuals identify hospitals with experience treating specific illnesses or conditions.
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Patient perceptions
For instance, a patient may evaluate the effectiveness of care by considering whether they received recommended treatments or interventions. This could include assessing the appropriateness and timeliness of surgical procedures, medications, or other therapies. Patient perceptions of safety are also crucial. Patients may consider whether they experienced any adverse events, such as hospital-acquired infections, pressure ulcers, or adverse drug reactions during their hospital stay.
Additionally, patient-centredness of care considers the extent to which patients feel involved in decision-making and if their preferences are respected. For example, patients may be offered a choice between different anaesthesia options for surgery. Hospitals may also evaluate patient perceptions of communication with healthcare professionals, the availability of information, and the level of respect and dignity they received.
Patient satisfaction surveys and feedback forms are common tools used to gather patient perceptions. These surveys may cover various topics, including admission and discharge processes, pain management, cleanliness and comfort of hospital facilities, availability of support services, and overall satisfaction with the care received. By analysing patient feedback, hospitals can identify areas for improvement and implement changes to enhance the patient experience.
Furthermore, patient perceptions can influence the development and refinement of quality measures. By involving patients and their families in the design and evaluation of healthcare services, hospitals can ensure that quality measures are relevant, meaningful, and responsive to patient needs. This collaborative approach helps align quality improvement initiatives with the priorities and expectations of those receiving care.
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Effectiveness and safety
Outcome measures are a critical tool for evaluating effectiveness. These indicators provide concrete data on whether patients are experiencing improved health or achieving desired health goals as a result of the care they receive. For instance, outcome measures may assess the percentage of patients who experience surgical complications or hospital-acquired infections. While outcome measures are highly relevant, they are influenced by numerous factors beyond the control of healthcare providers, making it challenging to attribute causality solely to the quality of care provided.
To address this challenge, risk-adjustment methods are employed. These mathematical models account for differing patient characteristics, such as health status, to isolate the impact of healthcare services on outcomes. Additionally, process measures are used alongside outcome measures to understand the specific actions taken by healthcare providers to improve health. Process measures may include the percentage of people receiving preventive services like immunisations or the administration of aspirin for AMI patients upon arrival.
Safety, a critical aspect of quality care, focuses on identifying and reducing preventable adverse events. Hospitals track and aim to decrease the incidence of hospital-acquired conditions, such as adverse drug events, pressure ulcers, and infections. Safety checklists during surgery and standardised protocols for patient care are implemented to enhance safety.
National organisations, such as the National Quality Forum (NQF) in the United States, play a pivotal role in endorsing quality measures. These measures are then used by private and public entities to assess and improve the quality of hospitals and healthcare services. Continuous efforts are made to enhance data collection methods and standardise health quality data to enable accurate comparisons and informed decision-making.
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Frequently asked questions
There are three types of measures used to assess and compare the quality of healthcare:
- Structural measures: These give an overview of a healthcare provider's capacity, systems, and processes to provide high-quality care. Examples include the use of electronic medical records, the number of board-certified physicians, and the ratio of providers to patients.
- Process measures: These indicate the actions taken by healthcare providers to maintain or improve health for both healthy individuals and those with specific conditions. Examples include the percentage of people receiving preventive services like immunizations and clinical guidelines such as administering aspirin to AMI patients.
- Outcome measures: These reflect the impact of healthcare interventions on patient health. Examples include surgical mortality rates, hospitalization rates for preventable conditions, and patient-reported experience measures (PREMs).
Hospitals use quality measures to identify areas for improvement and set goals for enhancing patient care. For example, by analyzing readmission rates, hospitals can develop strategies to reduce preventable readmissions and improve patient outcomes. Additionally, hospitals can compare their performance in key areas with other hospitals to drive innovation and adopt best practices.
Several organizations contribute to assessing and enhancing healthcare quality. The Centers for Medicare and Medicaid Services (CMS) implement quality initiatives to ensure accountability and public disclosure, focusing on quality improvement, pay for reporting, and public reporting. The National Quality Forum (NQF) brings together experts and stakeholders to endorse new quality measures, which are then used by private payers and the federal government to assess hospitals and physicians. The Commonwealth Fund also plays a role by analyzing quality data at the national, state, and local levels, often conducting original surveys to understand international comparisons.
Patients can refer to resources provided by state agencies and organizations like the Centers for Medicare and Medicaid Services (CMS) to find and compare nearby hospitals. They can also consult national rankings and reviews of hospital quality and safety from organizations like the Joint Commission and the National Committee for Quality Assurance (NCQA). Additionally, patients are encouraged to discuss quality measures and outcomes with their doctors or care teams to make well-informed healthcare decisions.
