What are quality measures in healthcare?

Creating quality measures in health care is the practice of using data to assess hospital and health systems performance based on various quality standards. Quality standards are benchmarks that help healthcare organizations measure resource utilization to support improvement with objective, fact-based information. There are many types of quality measures that evaluate care for everything from outpatient facilities to imaging facilities to entire hospital systems.

Quality measures can be established by a particular healthcare institution or it can rely on measures developed by government agencies, private nonprofits and even some for-profit companies. Once a healthcare organization sets its quality goals it then develops strategies to meet or exceed those goals. Quality measures can include the organization’s ability to provide effective, safe, timely, patient-focused and equitable care.


While healthcare organizations may have quality measures specific to their institution, outcome measures are generally established by large third-party organizations such as Centers for Medicare & Medicaid Services (CMS) and the National Association for Healthcare Quality (NAHQ).

Healthcare institutions may decide to exceed mandated quality measures to not only benefit patients’ quality of care, but to help with an institution’s marketing and contracting efforts.

Why are quality measures important?

Because healthcare costs have risen dramatically in the past 50 years —outstripping general cost of living increases —individuals and governments want verifiable, quality measures that provide evidence that these increases are justified.

Measuring the quality of healthcare can:

  • Guard against abuses and misuse of healthcare services
  • Ensure patient safety
  • Reveal areas where interventions might improve care
  • Identify how and where service improvements should be made
  • Help patients make more informed choices about the care they receive
  • Provide objective data for policy discussions about healthcare programs and investments
  • Act as test to see what healthcare processes and techniques work the best, to drive constant improvements
  • Keep healthcare providers and insurance plans accountable for higher standards of care
  • Shed light on inequalities in levels of service from different providers and different geographic regions

Using software for quality measures in healthcare

Measuring quality means collecting and analyzing data. But an exponentially-expanding volume of available health information makes data collection —let alone analysis —challenging. Additionally, the digitization of healthcare, accelerated by the deployment and adoption of electronic medical records, is now being exploited and augmented with technologies like mobile, social, cloud computing and analytics. 

Because of the dramatic increase of available data and its complexity, healthcare organizations are looking to software to make it easier sift through of this information. These organizations are looking to better analyze their true costs, quality of the service, risk models and segmentation of their populations and relationships with those they serve. Software tools specifically designed for the healthcare field can analyze and glean the relevant information from this ocean of data and help practitioners, researchers and caregivers discover, analyze and act on the information in innovative ways.

Some software packages incorporate artificial intelligence (AI) capabilities which fundamentally change the way humans and computers interact. With AI’s ability to “learn” the software can accelerate the work in clinical research, genomic studies, personalized medicine, as well can assist the transition to more person-centered care.These cognitive capabilities can significantly extend insight and knowledge by providing expert assistance right into a clinician’s or caregiver's workflow—enabling organizations to dramatically change how and where care is delivered.

 

Key features of effective quality measures

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.

 

Case studies

DeKalb Medical

Discover how IBM® CareDiscovery® fundamentally changed the way DeKalb monitored key metrics such as length of stay, mortality and readmissions. 

Schneck Medical Center

Learn how Schneck identified the root of the hospital’s rising readmission rate and formulated a plan to improve its patient-centric approach across the care continuum.

Blogs

Health Quest

Learn how the healthcare system closed gaps in care, generating $3.7 million in total billing revenue.

Rogers Behavioral Health

Discover how Rogers is seeing 1,000 more patients per year and achieving better outcomes.

Resources

Meet CMS Promoting Interoperability Program

Discover how you can meet both regulatory reporting requirements using the same solution.

Use intelligent data and analytics

Learn why Watson Health has been a leader specializing in clinical quality measures and quality reporting for core measures.

Watson Health 15 Top Health Systems Study, 2018

Read this annual quantitative study designed to shine a light on the nation’s highest-performing health systems.

IBM products related to quality measures in health care

Healthcare organizations need a suite of solutions and services to create a solid foundational IT infrastructure platform that helps to drive down costs, improve operational efficiency and track quality measures. IBM offers software products that are powered by advanced technology to help optimize costs, reduce risk, support compliance processes, enhance customer engagement, create new revenue streams and establish a security-rich and reliable infrastructure that's ready for AI and hybrid cloud.

IBM Watson Health solutions includes:

IBM ActionOI®

Assists in evaluating operational and financial performance in a realistic context, head-to-head with best-in-class performers.

IBM CareDiscovery®

Helps identify improvement opportunities using best-practice benchmarks.

IBM Cost and Care Insights

Visualizes clinical, operational and financial data intelligence to drive results.

Market Expert

Provides localized, market-specific data to help make strategic planning decisions.

IBM CareDiscovery® Quality Measures

Supports hospital clinical quality improvement initiatives by providing efficient quality measures reporting.

IBM CareDiscovery® Electronic Quality Measures

Assists hospitals in understanding data results and identifying ways to gather the required data within their existing hospital information systems (HIS).

100 Top Hospitals

Shows hospitals and health systems how their performance compares to peers or other system hospitals, and how they are trending over time.

Footnotes

1

Types of Health Care Quality Measures. U.S. Department of Health & Human Services. Agency for Healthcare Research and Quality. February 2015.

2

Care that Matters: Quality Measurement and Health Care. PLoS Med. 2015 Nov; 12(11): e1001902. Published online 2015 Nov 17

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