The American healthcare system has a quality problem. Despite spending over $3.6 trillion on medical care each year, up to 42% more than its peers in developed nations, the United States does not experience better outcomes. In fact, according to The Commonwealth Fund Report, the U.S. ranks last compared to six other industrialized countries.
Improving quality of care is a vital step in improving the healthcare system. To accomplish that requires a clear definition of what is meant by quality and an understanding of how it can be accurately measured.
Quality of care can be defined as the degree to which health services for individuals and populations increase the likelihood of desired health outcomes. A switch to value-based care models focuses on whether appropriate care was provided and if it was effective. Enlace Health clients have seen that as they focus on improved quality, we also are able to achieve a reduction in healthcare costs.
Here are the most effective ways healthcare quality can be measured:
- Efficiency of Care
- Eliminate Unnecessary Procedures
- Speed of Service
- Industry Standard Quality Metrics
- Patient Satisfaction
- Attributes of Healthcare Facilities
Efficiency of Care
One potential metric for measuring healthcare quality is the efficiency of care. This can be defined as the proportion of beneficial or necessary services to unnecessary or detrimental services. Efficiency of care is strongly correlated with quality outcomes because prioritizing only the most beneficial and necessary services increases the likelihood that each rendered service will contribute to the desired health outcome.
Eliminating unnecessary procedures minimizes the opportunity for complications or malpractice to occur, both of which negatively impact patient outcomes. An example of this type of efficiency metric is the National Committee for Quality Assurance (NCQA) Use of Imaging Studies for Low Back Pain measure, which evaluates unnecessary or routine imaging (X-ray, MRI, CT scans) for low back pain. This Healthcare Effectiveness Data and Information Set (HEDIS) measure analyzes unwarranted imaging services that can expose patients to unnecessary radiation and further unnecessary treatment.
Another way to measure efficiency of care is speed of service. This also impacts quality, as diminishing the time spent waiting for medical care decreases the likelihood of an adverse health outcome occurring before a patient is treated. Time-based metrics such as emergency room admission to triage and triage to examination are common speed of service quality indicators. The strong relationship between care efficiency and outcomes makes it a compelling method by which quality can be measured.
Industry Standard Quality Metrics
Other quality metrics to consider include complication, readmission, and emergency department visit rates. A complication is defined as a side effect resulting from medical care that works in opposition to the desired health outcome. A high complication rate can be regarded as a key indicator of a decline in quality of care. Similarly, readmission and emergency department (ED) visit rates imply an unexpected departure from the desired health outcome. Widely accepted throughout the healthcare industry, the below HEDIS measures track a population’s ED utilization and hospital readmissions:
- Emergency Department Utilization (EDU) – Assesses ED utilization among commercial and Medicare health plan members (18 and older).
- Plan All-Cause Readmissions (PCR) – Assesses the rate of adult acute inpatient and observation stays that were followed by an unplanned acute readmission for any diagnosis within 30 days after discharge.
Evaluation of patient satisfaction also provides insight into the quality of care for specific healthcare providers. The Oman Medical Journal reported various studies that have found patient satisfaction to be a “realistic tool to provide opportunity for improvement, enhance strategic decision making, reduce cost, meet patients’ expectations, frame strategies for effective management, monitor healthcare performance of health plans and provide benchmarking across the healthcare institutions.” Most businesses can benefit from customer feedback, and healthcare providers are no different. Patients that report higher levels of satisfaction are more likely to comply with treatment and remain with the same healthcare provider, which helps with continuity of care. These in turn tend to contribute to better health outcomes. Although patient satisfaction can be difficult to quantify in a uniform way, it is clear that it has utility as a metric for quality. Throughout the United States, patient satisfaction is commonly reported using the Agency for Healthcare Research and Quality (AHRQ) Consumer Assessment of Healthcare Providers and Systems (CAHPS) program. This is a requirement for many organizations, including the Centers for Medicare & Medicaid Services (CMS).
Patient satisfaction for facilities is also tracked using the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey. This is the first national, standardized, publicly-reported survey of patient perception regarding hospital care, helping to fulfill the Triple Aim goal of improving patient experience.
Attributes of Healthcare Facilities
Another strategy for determining quality of care is to evaluate various attributes of healthcare facilities. Example metrics here include whether or not the facility utilizes electronic health records, has its own cardiac catheterization laboratory or advanced imaging equipment. The ratio of providers to patients also can be an indicator impacting quality outcomes, as can the volume of preventative services administered. Evaluating facilities to determine quality of care is appealing because facility capabilities and information are generally easy to collect by simple survey or inventory.
The current shape of healthcare in the United States provides strong evidence that higher cost does not equal better quality. Quality metrics are important to measure and track over time to identify key trends and implement corrective measures where appropriate. By itself each metric has limitations, but combined measures such as these can provide an accurate picture of the quality of care in America and will help improve overall healthcare outcomes.
Improving Efficiency and Value in Health Care
Improving Patient Experience and Reducing Cost by Measuring Outcomes
Measuring the Quality of Health Care
Patient Satisfaction Survey as a Tool Towards Quality Improvement
Quality Measurement in Healthcare
The Impact of Personalized Preventive Care on Health Care Quality, Utilization, and Expenditures
HEDIS Measures and Technical Resources
Agency for Healthcare Research and Quality
U.S. Ranks Last Among Seven Countries on Health System Performance Measures