Identifying and Analyzing Care Quality Measures

caring african medical nurse comforting senior patient in office

By Julie Walker, Executive Vice President and Managing Director of Governance, Risk and Compliance Solutions for symplr

When patients go to the hospital or attend routine doctor’s appointments, they expect high-quality care. However, in fee-for-services healthcare models, the industry is focused on generating more appointments, more tests, and more services. Value-based care and value-based payment models flip this paradigm on its head, putting quality-focused initiatives at center stage as providers, payers, and other stakeholders work together to improve patient outcomes, reduce resource utilization, and more.

Amid these efforts, tracking quality and overall patient outcomes is essential, but challenges persist. Many healthcare organizations remain stymied about how to identify the most appropriate quality metrics to measure, how best to monitor them, and how to make quantifiable improvements to healthcare processes, outcomes, and organizational structures. A lack of consensus on the definition of “quality” is one such hurdle. With hundreds of quality measures, quality can be quantified in many ways. 

Health systems should choose quality and risk-management metrics based on the organization’s needs, the specific reporting requirements of its payers (including CMS’ quality programs), and its accrediting body (e.g., The Joint Commission). These metrics will likely include:

  • Mortality: The patient mortality rate measures the percentage of patients who die in a hospital’s care before being discharged. Mortality rate is a strong indicator of a provider’s/provider team’s ability to stabilize a patient’s condition following surgery or another procedure.
  • Safety of care (medical incidents): Safety metrics are related to medical incidents, including errors and adverse events. Hospital incidents include unintentional consequences or side effects of hospital procedures, including conditions like sepsis, postoperative respiratory failure, pulmonary embolisms, hemorrhages, and other reactions or infections. 

These measures reflect healthcare professionals’ ability to provide comprehensive, high-quality patient care without triggering an adverse reaction. The number of harm events per 1,000 patient days is one way to quantify this measure.

  • Hospital readmission rate: This metric refers to the percentage of patients who are readmitted to the hospital within 30 days of being discharged for the same condition or a complication resulting from treatment. High hospital readmission rates indicate that physicians and other care providers are not delivering the proper care to patients, perhaps because they are overlooking complications or relevant patient data. Lower hospital readmission rates indicate higher care quality.
  • Patient satisfaction/patient experience: Patient-reported outcome measures assess patients’ experiences and perceptions of their healthcare. You can evaluate these by tracking complaints and administering patient satisfaction surveys.
  • Timeliness and effectiveness of care: Timeliness of care metrics (e.g., waiting times, such as the time from arrival at the ED until diagnostic evaluation) are related to patient access to care. Effectiveness of care outcomes measures evaluate two things: compliance with best practice care guidelines (e.g., the percentage of patients receiving recommended hospital care for specific conditions such as heart attack), and achieved outcomes (e.g., lower readmission rates for heart failure patients).
  • Efficient use of medical imagery: Advanced medical imaging includes tests such as computed tomography (CT) scans and magnetic resonance imaging (MRI). If used appropriately, medical imaging is an important part of the diagnosis and follow-up for many medical conditions. If used inappropriately, however, medical imaging can be costly in terms of expense, wait times, and, in some cases, unnecessary exposure to radiation.
  • Telehealth and AI: Beyond access, a variety of other telehealth quality measures should be compared to in-person care, including diagnostic accuracy, unplanned Emergency Department (ED) visits/hospitalizations, no-show rates, medication adherence, and patient satisfaction.
  • The Joint Commission’s six general competencies: These competencies for measuring and improving provider performance include: Interpersonal and communication skills, professionalism, systems-based practice, medical/clinical knowledge, patient care, and practice-based learning and improvement. 

Managing quality data with technology

Healthcare organizations generate vast quantities of quality-related data, so managing and interpreting that data can be challenging when it’s stored in separate systems throughout an organization. Quality management dashboards increase the visibility and transparency of key quality data metrics and measures. Like a car’s dashboard, healthcare quality dashboards provide a visual representation of data that guides decision making. When a driver knows how fast their driving, they can make informed decisions about altering speed. Similarly, when a quality assurance or quality improvement supervisor knows how many adverse events occurred in the ICU last month, they can decide what corrective actions to take. This data can be used to compare current and past performance, performances across departments and facilities, and ultimately help identify areas for quality improvement. It can also help track responses to operational changes and quality improvement initiatives. As a result, these systems have been reported to improve patient safety by reducing infection rates, medication errors, and falls.

Managing the complexities of quality, risk management, provider performance, and patient outcomes is no small task. As healthcare continues to move toward value-based care and value-based payment, it’s important for health systems to focus on the right metrics to streamline the collection and analysis processes while also recognizing that quality metrics will vary widely based on the health system’s location, patient population, and affiliated payers and partners. Once those are clearly established, health systems should be sure to keep a pulse on how their facilities perform. By doing so, provider organizations enhance their ability to care for patients efficiently while also future-proofing their revenues for the value-based care and value-based payment ecosystem that will inevitably dominate the space in years to come.

Julie Walker serves as the Executive Vice President and Managing Director of Governance, Risk and Compliance Solutions for symplr. She has full P&L responsibility, which includes developing and implementing a comprehensive symplr GRC business plan, leading the time to ensure clear alignment with stakeholders, and driving organizational success. She also oversees the effective integration of new acquisitions, further solidifying and strengthening symplr’s market position to deliver meaningful value for our customers. Previously, Walker successfully led the company’s strategy and corporate development efforts and transformed symplr’s Workforce Management and Access Management business segments. Prior to symplr, Walker served in a senior role at ProviderTrust, and was Vice President of Sales at the National Healthcareer Association, a division of Ascend Learning – both SaaS healthcare technology companies. She received a Bachelor of Business Administration degree from Valparaiso University and a Master of Business Administration degree from Lipscomb University.