Measuring care quality is an important step in improving the quality of care and in securing appropriate financial incentives in a value-based care environment. The Centers for Medicare & Medicaid Services (CMS) emphasizes that quality measures are the “standards for measuring the performance of healthcare providers to care for patients and populations.” The most important care quality measures depend on the provider, the patient population, and the relevant goals for the practice.
Each measure of care quality focuses on a different aspect of healthcare delivery, including:
- 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.
The Agency for Healthcare Research and Quality (AHRQ) recommends considering whether the measures of care quality are appropriate for the measurement audience. The organization also explains that quality measures can be used to evaluate the performance of an independent provider or a group of physicians practicing together. Most quality information is at the level of practices or medical groups.
AHRQ points out that the availability of a larger patient population is one advantage of constructing scores at the group level. Measuring care quality at the medical group level can be done by combining patient data from each provider in the group. Data can be secured from the practices’ electronic health records (EHRs) for more efficient and accurate reporting.
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Measures of care quality are important to determine how the healthcare delivery system is performing as well as the level of quality in patient outcomes. Measures help to identify a practice’s weaknesses and to prioritize opportunities for driving improvement in care. In addition, in a value-based care environment, measures of care quality are important relative to payment for the independent provider.
Toward this end, the most important care quality measures are those that are:
- Relevant to the practice and the patient population served by the practice
- Addressing gaps in care
- Aligned with the goals of the practice
- Aligned with initiatives such as the Merit-Based Incentive Payment System (MIPS)
- Are relevant and important to the practice’s patients in regard to their health outcomes.
AHRQ outlines the six domains of healthcare quality as included in the framework put forth by the Institute of Medicine (IOM), one of the most influential for care quality assessment. The six aims for healthcare delivery focus on it being:
- Safe: Avoiding harm to patients from the care that is intended to help them.
- Effective: Providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit (avoiding underuse and misuse, respectively).
- Patient–centered: Providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.
- Timely: Reducing waits and sometimes harmful delays for both those who receive and those who give care.
- Efficient: Avoiding waste, including waste of equipment, supplies, ideas, and energy.
- Equitable: Providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status.