Quality Measures
The Progress & Performance Report contains 39 health care quality and experience measures reported by general acute care hospitals to the Centers for Medicare & Medicaid Services, the Joint Commission, and the Pennsylvania Health Care Cost Containment Council. While most hospitals have data available for all measures in the report, some do not because of the health care services they offer, the low number of patients, or their Joint Commission accreditation status. Access to health quality data from multiple sources in one location is an advantage that PHCQA is able to provide the public.
The initial Progress & Performance Report launched in March 2008 focused on process and outcome measures that fell into four major clinical areas or topics: heart attack, heart failure, pneumonia, and surgical care and infection prevention. These areas represent some of the most common and most commonly measured services hospitals provide. In our Fall 2008 update to the Progress & Performance Report, we have added two new dimensions to our measure set: appropriate care measures, which are composite measures, and consumer assessment scores, which are patient experience measures.
Process Measures vs. Outcome Measures
Each measure in the heart attack, heart failure, pneumonia, and surgical care and infection prevention clinical areas is categorized as either a process or outcome measure as indicated by the heading above the measure and the associated performance data. Process measures assess the quality of a specific health care service provided to an individual. Providing aspirin to a heart attack patient upon arrival to the hospital is an example of a process measure because it measures whether a process or a step took place or not. On the other hand, outcome measures assess performance on a broader scale. Outcome measures gauge the comprehensive result of multiple health care services provided to an individual. Readmission (to the hospital) and mortality (death) rates are examples of outcome measures. More detailed descriptions of each type of measure are provided below:
Process Measure — a process measure assesses a health care service provided to, or on behalf of, a patient. Process measures are often used to assess adherence to recommendations for clinical practice based on evidence or consensus. To a greater extent than outcome measures, process measures can identify specific areas of care that may require improvement.
Outcome Measure — an outcome of care is a health state of a patient resulting from health care. An outcome measure can be used to assess quality of care to the extent that health care services influence the likelihood of desired health outcomes. Outcome-based measures of quality reflect the cumulative impact of multiple processes of care. Outcome measures may suggest specific areas of care that may require quality improvement, but further investigation is typically necessary to determine the specific structures or processes that should be changed. (Source: AHRQ)
Composite Measures
Composite measures or scores are a combination of two or more individual measures into a single score. While individual measures can provide important information on the quality of specific process steps or clinical outcomes, composite measures summarize performance by combining the information from many measures into a single score. The composite measures used in our report are the Appropriate Care Measures. These measures show the percentage of patients who received all the recommended care they were supposed to have received during their hospital stay based on their condition.
Patient Experience Measures
Patient experience measures attempt to capture the patients’ perspective of their experience in the hospital. The patient experience measures used in our report are the Consumer Assessment scores, which are derived from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). HCAHPS is a standardized, nationwide survey that measures various aspects of patients’ experiences during their hospital stay. This survey differs from patient satisfaction surveys because it does not assess patients level of satisfaction derived from such events.
