The Agency for Healthcare Research and Quality (AHRQ) has outlined the three types of quality measures using the Donabedian classification model (1). Measures are classified as structure, process or outcome measures.
Structure measures. Structural measures are the health care provider’s overall ability to provide high quality care: the institution’s capacity, systems and processes.These measures may include whether the organization uses more modern electronic medical records and medication order entry systems. Measures could also include how many board-certified physicians are on staff or the ratio of providers to patients.
Process measures. Process measures are what the institution does to maintain or improve health. These measures can reflect both preventative measures or those already experiencing health issues. These measures should evaluate how the institution is meeting generally-accepted standards of practice. Most publicly-reported health care quality measures are process measures.
Outcome Measures. Outcome measures reflect the impact the institution’s patient interventions and how they improved the health of patients. Examples of outcome measures include rates for surgical mortality, surgical complications and hospital-acquired infections.
Though quality measures have the potential in improve healthcare, some healthcare professionals (2) have warned that there is only limited evidence that many quality measures result in improved health outcomes —including those that are tied to incentives by insurers or governments. Despite this, quality measures and comparative quality ratings continue to increase in popularity—likely because the measures are based on intermediate endpoints such as risk-factor control or care processes that are vulnerable to gaming, over-test and over-treatment. Instead, quality measures should be based on patient-centered outcomes, with individualized approaches to clinical complexity.