Quality-of-Care Measures

The need to measure healthcare organizations' quality and to make the information available to stakeholders in the healthcare system is recognized as essential to improving care and enhancing patient safety. Among the most common uses of healthcare organizations' quality measurements are the following:

External stakeholders' use of quality measurement data can affect hospitals in many ways and may have important implications for their bottom line, reputation, and accreditation status. As a result, hospitals' efforts to monitor quality measures increasingly have the attention of hospitals' senior executives and boards of trustees. Governing boards, along with the organization's senior leaders, are held accountable for the organization's meeting quality goals to ensure safe care, as well as its solvency.

Hospitals can no longer approach performance improvement projects as a series of individual initiatives. Instead, performance monitoring and improvement must be a robust, organization-wide effort, involving senior leaders and applying rigorous processes for data collection, measurement, and improvement (Austin et al. “From Board to Bedside").

This guidance article provides a brief overview of quality measurement, summarizes the use of performance measures by various stakeholders, and provides recommendations for an effective quality program to meet internal and external demands for performance data. Much of the information is applicable to hospital settings, although the general concepts of quality measurement and principles for a quality program apply to all healthcare settings.

Healthcare quality is defined as “doing the right thing for the right patient, at the right time, in the right way to achieve the best possible results. " (AHRQ “Guide to Health Care Quality")

When quality is poor and breakdowns occur in healthcare processes, patients can be harmed as a result of receiving the wrong care, not enough care, too much care, or delayed care. The Institute of Medicine (now called the National Academies of Sciences, Engineering, and Medicine) shined a light on these concerns with its 1999 report To Err Is Human: Building a Safer Health System about medical errors and its 2001 report Crossing the Quality Chasm, which found scant evidence of progress in healthcare quality and safety. The latter report sets forth national measurement and improvement objectives for healthcare quality.

One widely cited study from 2003 looked at 439 quality-of-care indicators for 30 acute and chronic conditions as well as preventive care and found that only 55% of randomly selected adults from 12 U.S. metropolitan areas received recommended care. Just over 6,700 adults were included in the analysis. (McGlynn...