Assignment: Methods for Measuring Healthcare Quality Essay
Assignment: Methods for Measuring Healthcare Quality Essay
In health care, quality measurement is defined as the practice of using data to assess health plans and performance of health care professionals based on accepted standards of quality. Quality measures are tools that assist in gauging and quantifying healthcare practices, outcomes, organizational structures, patients’ viewpoints, and systems that are attributed to the potential of delivering quality health care. The ultimate goals of quality measures include provision of quality, effective, efficient, safe, equitable, timely, and patient-centered care (CMS, 2019). Essentially, quality measures are multifaceted and monitor care across the entire health care organization. Measuring quality in health care is a crucial component of health care quality enhancement process. Often, the quality of care in America is marred by considerable imperfections. Studies indicate that there is significant underutilization, overutilization, and misuse of care services. Besides, provision of health care is disjointed, disorganized, and intricate; hence, exposing patients to the risk of severe harm or even death.
In turn, quality measurement act as a critical tool for enhancing health care delivery by ensuring that challenges such as underutilization, overutilization, and misuse of health care services are avoided. As a result, quality measurement helps in improving patient safety, increasing accountability of health insurance plan and health care professionals for delivery of quality care, recognizing what works best or what does not foster health care improvement, guiding health care consumers in making informed decisions on their health care, and determining and addressing health care disparities and outcomes.
Quality measures are categorized into three types including structure, outcomes, and process measures that are established to evaluate and contrast health care quality in organizations. Consequently, this paper seeks to delve into these three measures by exploring different aspects of these measures such as their definition, numerical depiction, techniques of data gathering, how both compare externally to the same settings, whether or not every measure is risk adjusted, and the kind of objectives health care settings may set based on each measure. Moreover, the paper will also highlight the essence of all the three measures to the health care organization. The paper will also strive to associate the three measures with patient safety, the cost accumulated from poor quality, and the general health care cost.
Fundamentally, structural measures are crucial in providing the consumers with a picture of the health care provider’s capacity, processes, and systems to foster quality care (Kessell et al., 2015). For instance, the measures will depict a number of factors such as the ratio of physicians to patients, the number of certified physicians, and whether the health care setting uses healthcare informatics such as electronic health records or medication order entry systems. Based on this backdrop, structure measures can, therefore, be defined as methods of assessing the health care organization’s infrastructure. The infrastructure may encompass the hospitals or physician offices, and if such settings have the capacity to provide patient care (AHRQ, 2019). Moreover, structure measures also encompass factors such as the policy situations in the facilities that provide care, staffing of facilities and workforce proficiency, and accessibility of resources with the health care setting. Overall, structural measures aim at evaluating the features of health care organization in relation to several aspects such as workforce, policies, and facilities that help in health care delivery (AHRQ, 2019). The structure measures are critical to the health care consumers in making informed decision on the choice of the facility to seek care because they portray the capability, systems, and processes of the care providers to deliver quality care. In many instances, structural measures are utilized in certification or endorsement programs that establish the mi minimal prerequisites for health care settings. As such, structure measures may be resourceful in providing blue print for the health organizations to follow in situations where the organization assumes responsibility for fresh activities or new populations.
Organizations such as Leapfrog group, which is tasked with responsibility of designing and sustaining a measure set intended for health facility quality and safety practices designed one of such measures. Besides, the quality indicators (QIs) developed by the Agency for Healthcare Research and Quality (AHRQ) are increasingly being used by many report card sponsors to determine structure measures. Principally, structure quality measures are categorized into four areas of measurement including prevention, patient safety indicators (PSIs), inpatient quality indicators (IQIs), and pediatric quality indicators (PedQIs). The structure quality measures are construed as ratios. In this construction, the numerators cases may or may not be accommodated within the denominator, and the denominator is regarded as the most appropriate substitute available for the existing population at risk. This situation is attributed to the fact that the population cannot be enumerated (AHRQ, 2019b). Notably, the quality measures were originally designed for numerous objectives such as pay-for-performance initiatives, enhancement of health care quality, and assessment of public health. Regarding the sources of data in this quality measurement, several sources are available including national associations, health care organizations, or state agencies. Besides, data can also be sourced from administrative data for AHRQ’s QIs measures (AHRQ, 2019b).
Primarily, the IQs and PSIs developed by AHRQ characterize health outcomes. Therefore, they are susceptible to the morbidity lumber of the patient population. As such, they should be risk adjusted to enable convincing quality comparisons. The measures apply the All Patient Refined Diagnosis-Related Groups (APR- DRGs), which is a system developed by 3M Health Information Systems (3M, 2016). The APR- DRGs refers to a risk modification system that considers every patient irrespective of whether or not they are insured under the Medicare. This risk modification system operates on the basis of two standards including the categorization of high rigorousness of the disease and mortality risk by various illnesses and succeeding interface of such illnesses. However, the risk of mortality and gravity of the disease rely on the primary conditions of the patient (3M, 2016).
While determining the structural quality measures, it is imperative for the health care settings to create goals and work towards attaining a specific percentage of customer satisfaction. For example, the intensive care unit (ICU) may set a goal of ensuring 80% patients satisfaction in managing pain during the hospitalization. This goal may be distinguished further by personal patient satisfaction indicators, and consequently an average is deliberated to provide the entire satisfaction score for the health care organization. Determination of percentage of customer satisfaction is essential to the health care facility because it enables the organization to assess the areas of their strengths and weakness areas that requires improvement. Essentially, the present society is characterized by significant patient acuity in modern medicine and the health care consumers are increasingly gaining insights of the health care industry and their involvedness in determining the care they want. Therefore, in an effort to deliver patient-centered care, health care organizations should be in a position to demonstrate the effectiveness of the care they provide. Regarding the comparison with other facilities, it is appropriate to hold outpatient facilities to a distinct array of standards depending on the level of care such outpatient facilities provide. For example, the patients should be worried about the time they spend on waiting to see physicians, but they should not be worried by the quality of the food since food is not part of the services offered.
Outcome measures work by monitoring health of the patients based on the care they received. That is, outcomes measures considers both deliberate and accidental effects that care create on patients’ health, functionality, and health status. The outcome quality measures also evaluate whether or not the objectives of the care are attained (Wiering, de Boer & Delnoij, 2017). Essentially, outcome measures forms the epic of quality measurement in health care. Fundamentally, the crucial aim of patients is to survive the sickness and have their health status improved but not the organizational process that supports these outcomes. Outcome measures often encompass conventional measures of survival (mortality), prevalence of disease (morbidity), and concerns of quality of life associated with health. Although these measures mostly integrate reported information concerning the level of patient satisfaction with care delivery services provided to them, these measures cannot fully ascertain the entire patient experience. Despite the importance of the outcome measures to patients and care providers, their essence is challenged on the ground of problematic establishment of a truly meaningful measures. Besides, it is difficult to collect sufficient information to provide meaningful data concerning a specific outcome.
As indicated above, outcome measures basically pinpoint the influence of the health care intervention or services on the patients’ health status. Often, an outcome connotes the results that emanate directly from array of factors, with some being beyond the power of the providers. Essentially, many tools can be used to assess the outcome measurement including the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospital Survey also known as the Hospital CAHPS or HCAHPS. The HCAHPS refers to a consistent survey tool and data gathering technique for determining the opinions of the patients regarding their care during their stay in the hospital. The HCAHPS was designed by the Centers for Medicare & Medicaid Services (CMS) and the Federal Agency for Healthcare Research and Quality (AHRQ) to deal with crucial sides that patients experience during the hospital stay such as receptiveness of the facility’s workforce, pain control, communication with clinicians, discharge information, medication communication care changeovers, hygiene and quietness of the hospital. The construction of this technique involves use of percentages and proportions method that encompasses use numerous performance ranging between 0% and 100%. This method enables several measures to be effortlessly averaged to facilitate generation of amalgamated measures and also to foster contrasting of performance in different measures ad sites. The method is straightforward and so, it is practical for the health care providers and also comprehensible to the health care consumers. For instance, contends that most of the survey questions captured in HCAHPS concerning experiences with patient care have been altered from their initial version such as “how often did your primary care doctor…” to a dichotomous interpretation such as “always”/”usually/never” compared to other responses. As a result, it is now possible to convey the responses in percentile quantity of patients having finest or near finest experiences (AHRQ, 2019b)
The data from HCAHPS can be acquired directly from the hospital or through visiting the Hospital Compare Website. Mostly, the assembled data is kept by the hospital and forwarded to the federal government. On their side, the CMS tend to apply risk modification when considering the variations in the risk factors at the level of the beneficiary that impact the outcomes of the quality or the costs of the medical intervention irrespective of the kind of care given (Wasfy et al., 2017). Essentially, the risk adjustment utilized by the CMS entails approximation of the anticipated Medicare Taxpayer Identification Number’s (TIN’s) behaviors on quality measures or their projected Medicare tolerable expenses for cost measures, against the clinical intricacies of their recipients. In turn, this approximation is weighed against their real performance, and subsequently multiplied by the countrywide average to facilitate generation of a substantial score of measure.
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In the process of deliberating outcome measures in the intensive care unit (ICU) setting of the facility, it is important to set goals for the health care facilities to assist in enhancing the communication, coordination of care provision efforts, and to help in establishing effective team work with health care providers and patients concerning the post-discharge planning. These goals are
critical to the ICU settings since readmission of patients shortly after discharge could attract some penalties such as the risk of subjecting the hospital to possible reduction of paid benefits associated with the care of patient during readmission care by CMS through the Affordable Care Act (Wasfy et al., 2017). Therefore, to avoid costly incidences of paying individually for the care of patients after being readmitted, it is advisable to for the health care organizations to strive for flawless discharge and transition. On the other hand, other care settings including outpatient clinic do not have the concerns about benefit reduction since the patients visiting such settings often present with minor diseases and they tend to have significantly reduced association with health care providers before being discharged. However, they are exposed to the public while in the process of recovering from the sickness, making them susceptible to attract other diseases that may prompt the patients to return back to the hospital. Therefore, in the ICU settings, the clinicians are required to most of these exposures while delivering more comprehensive treatment and sufficiently preparing the patients for discharge.
Process measures are characterized by of the level in which health care providers go to provide health care to patients based on best care guidelines. In other words, process measures imply identification of particular actions taken by the health care providers to uphold and enhance health (AHRQ, 2019). Mostly, the process measures are associated with established treatments or processes that have been proven to optimize status of health or safeguard from future barriers or health conditions. Usually, process measures tend to depict the universally accepted outcomes emanating from the health care provided. Most importantly, the measures tend to assess the impacts, deliberate or involuntary, that care provided cause on the health, health status, and function of the patients. The measures are crucial because they provide a succinct, practical view to the providers which facilitate uncomplicated blue print of enhancing the performance. Moreover, the measures also explores whether or not the projected objectives of patient care are attained. In clinical practice, the Joint Commission’s ORYX is one of the types of process quality measure. Fundamentally, ORYX refers to an array of performance measurement necessities that are applied to monitor and endorse health care settings and programs (Heuer, Rankin, Reyes & Dihigo, 2019). Like outcomes measurement, this quality measure is equally constructed through establishment of proportions and percentages. The information about ORYX measures can be sourced from the Quality Check section of the public quality report of the joint Commission. The users can access the performance of their preferred organization online or download the information freely. The data include particular facility’s scores and federal and state comparative data.
Notably, the ORYX entails a risk adjusted measure and so, it is appropriate for the its dealers to make necessary data preparations for risk modification through locating the measure population to apply the risk adjustment. Moreover, it is highly advisable that the twofold risk factors should be recognized and noted down to show the existence or otherwise of a risk factor. Nonetheless, owing to incessant risk factors, it is important to use the definite value with the adjustments. However, in situations where the needed risk factors such as age, source of admission, or sex cannot be found either by missing or blank, there is need to allocate approximated value for every missing or blank risk factors. Consequently, Risk Models obtained from the Risk Model Information File issued by the Joint Commission is required to be used in the data to help in computing the anticipated values for every care occurrence in the measure population for risk modified measures. In turn, the values obtained forms the anticipated values that are conveyed to the Joint Commission for all contributing health care settings. Subsequently, all risk modified components of data for the measure in every health care setting is required to be computed and conveyed cumulatively to the Joint Commission as HCO-level data file.
On the other hand, while taking process measures and goal setting for ICU settings into account, it is important to set goals to help in the health care setting take necessary actions to evade the development of relapse in patients. Process measures are crucial in helping the performance of internal audits and help the organizations to enhance their patient related process during patient care. These quality measures are mostly anchored on evidence-based practices which are used by the health care organizations to implement the necessary valuable interventions. On the other side, in consideration of how the process measures can be used in an outpatient clinic as weighed against ICU setting, it is appropriate to consider the intensity of care offered by each facility. Understandably, each facility is expected to poses distinct processes and procedures for specific kinds of care. However, it is reasonable to believe that ICU setting ideally needs a more comprehensive care than outpatient clinic owing to the seriousness of the diseases presented in ICUs. Besides, ICUs generally undertake several activities such as therapies, lab tests, and diagnostics tests compared to outpatient clinic, as such, ICUs needs significantly more and thorough supervision to realize patients’ safety.
It has been established in the paper that all the three quality measures have critical roles to play in the improvement of the patient safety. In particular, the structural measures have been shown to help the patients in making informed resolve about the safety levels and standards of the health care organizations prior to making a decision of whether or not to use the facility to provide their care. On the other hand, process measures are important to the facilities because they provide a platform for the facilities to assess themselves and advance their processes in the areas of weakness to realize patient safety. On their side, outcome measures stresses on accountability in the facilities to enhance patient safety, with government stepping in to restore confidence to patients and their close relatives. Contrastingly, the costs associated with poor quality in each of the three measures are massive. To begin with, wanting structural measures is risky to the organization as it leads to loss of confidence by the patients, thus, looking for the care in other facilities and eventually causing dire impacts to the bottom line of the facility. Likewise, poor process measures leads to a situation where the facility provide incoherent care. Besides, the staff becomes reluctant leading to fears of patient safety. On their side, the poor outcomes measures attracts punitive consequences for the facilities for failing to attain the thresholds of safe and quality patient health care. Taken together, failing to achieve these quality measures can result to dire repercussions such as increased cost of care emanating from deteriorating patient health which in turn, prolongs hospital stays, leads to shortage of workforce, medical errors, lost of financial income.
In an 8 to 10 page paper, describe three rate based measurements of quality.
Select three rate based measurements of quality that you will use as the primary basis for this paper.
These measurements must relate to some aspect of clinical or service quality that directly relates to patient care or the patient’s experience of care. For the purposes of this assignment, an analysis of staffing levels is not permitted. You can find useful information on quality indicators that are of interest to you on these websites and resources. You may choose only one of the three measures to be some form of patient satisfaction measure.
Deconstruct each measure to include descriptions of the following:
The definition of the measure
The numerical description of how the measurement is constructed (the numerator/denominator measure counts, the formula used to construct the rate, etc.)
Explain how the data for this measure are collected
Describe how the measurement is compared externally to other like settings; differentiate between the actual rate and a percentile ranking.
Explain whether the measure is risk adjusted or not. If so, explain briefly how this is accomplished.
Describe how goals might be set for each measure in an aggressive organization, which is seeking to excel in the marketplace.
Describe the importance of each measure to a chosen clinical organization and setting.
Using these websites and resources you can choose a hospital, a nursing home, a home health agency, a dialysis center, a health plan, an outpatient clinic or private office; a total population of patient types is also acceptable, but please be specific as to the setting. That is, if you are interested in patients with chronic illness across the continuum of care, you might hone in a particular healthplan, a multispecialty practice setting or a healthcare organization with both inpatient and outpatient/clinic settings. Faculty appointments and academic settings are not permitted for this exercise. For all other settings, consult the instructor for guidance. You do not need actual data from a given organization to complete this assignment.
Relate each measure to patient safety, to the cost of poor quality, and to the overall cost of healthcare.