The healthcare industry is challenged with administrative and regulatory intricacies that make achieving the healthcare objectives, such as better patient outcomes and reduced costs, difficult. Difficulties faced while improving patient outcomes are predominantly taxing, since health systems measure and report thousands of outcomes annually. (1) In addition, healthcare industry is saturated with the need for improved quality and safety programs. (2) Quality healthcare refers to “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge”. (3)
Moreover, healthcare is moving from the ‘volume of services delivered’ to the ‘value’ created for patients, which is defined as the outcomes achieved relative to the costs. (4) However, this shift has been slow, to a certain extent, owing to the restricted measurement of outcomes that matter to patients, except survival. In addition, ‘death’ is an unusual outcome in many situations, wherein the measurement fails to differentiate excellent from merely capable providers. (5)
“To Err Is Human”! Also, most of the medical errors originate from defective systems and processes, not individuals. These incompetent and inconsistent processes, changing patient cases and health insurance, varying degrees of healthcare providers’ education and expertise, and various other aspects add up to healthcare complications. Many believe that the healthcare industry today operates at a lower level than it can and should; however, it should focus on more comprehensive goals, such as efficient, safe, patient-centric, well-timed, and unbiased care delivery. The efficacy and safety intentions can be delivered through process-of-care measures, assessing whether the processes achieve the desired goals while avoiding those that prompt the harm. Measurement of healthcare quality determines the effects of healthcare on desired outcomes and also assesses the degree of adherence of healthcare to processes that are evidence-based or those adhering to the general consensus that is in line with patient preferences. (6)
There are many outcome measures, ranging from changes in blood pressure in patients with hypertension to patient-reported outcome measures (PROMs). However, there are seven main outcome measures which are used by healthcare institutions and other stakeholders, viz. mortality, rehospitalizations, safety, efficacy, patient experience, timeliness of care and efficient use of medical imaging and other markers. Having said that, processes to accomplish the outcomes are as important as is achieving those outcomes. Process measures determine provider productivity and adherence to standards of recommended care. For example, to reduce the incidence of skin breakdown, a particular health system may apply the process measure to perform the risk evaluation by using Barden Scale for reducing pressure ulcer risk in all the appropriate units in the organization/institution. If health systems are focused on an outcome too much, they may lose track of the process. (1)
Apart from all the shortcomings, the primary goal of the healthcare systems and organizations globally is to improve patient outcomes. However, this improvement cannot take place without efficient measurement. As all the stakeholders work attentively to achieve the composite healthcare goals, they need to prioritize the outcomes measurement tools: transparency, integrated care, and interoperability. When used along with each other, these tools can improve and maintain outcomes measurement efforts by generating a data-driven culture that embraces data transparency and an integrated care environment to treat patients. This also improves critical care transitions and interoperable systems, which facilitates the perfect exchange of outcomes measurement data between clinicians, departments, and hospitals. (1)
(1) Tinker A. The top 7 outcome measures and 3 measurement essentials.
(2) National Healthcare Quality Report. Rockville, MD: Agency for Healthcare Research and Quality; 2006.
(3) Lohr KN, et al. A strategy for quality assurance in Medicare. N Engl J Med. 1990; 322:1161–71
(4) Porter ME. What is value in health care? N Engl J Med 2010; 363:2477-2481
(5) Porter ME, et al. Standardizing patient outcomes measurement. N Engl J Med 2016; 374:504-506
(6) Hughes RG. Tools and Strategies for Quality Improvement and Patient Safety. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr. Chapter 44.