Quality metrics in Health care

What are Quality Measures?

According to CMS, “Quality measures are tools that help us measure or quantify healthcare processes, outcomes, patient perceptions, and organizational structure and/or systems that are associated with the ability to provide high-quality health care and/or that relate to one or more quality goals for health care.”

In other words, they set the goals we use to effectively tack and manage population health.

What do they measure?

The various measures look at a different aspect of the system and together provides a comprehensive view of the quality of healthcare

. Quality measures includes:

  • Health outcomes
  • Clinical processes
  • Patient safety
  • Efficient use of healthcare resources
  • Care coordination
  • Patient engagement in their own care
  • Patient perceptions of their care
  • Population and public health

Why Use Them?

Measures inform us about how the health care system is performing. Measures help identify weaknesses, prioritize opportunities; Measures drive improvement. Measures are becoming increasingly important relative to payment as the U.S. health care system shifts away from traditional fee-for-service toward payment focused on the value of care.

How are they collected or reported?

Depending on the measure, data can be collected from different sources, including medical records, patient surveys, and administrative databases used to pay bills or to manage care. They are then analyzed internally for performance improvement and/or also reported to the various regulatory authorities (CMS, NCQA ETC) via claims- direct link or via registry, for benchmarking purposes.

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