Int J Qual Health Care-2001-Rubin-469-74

Int J Qual Health Care-2001-Rubin-469-74 - International...

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International Journal for Quality in Health Care 2001; Volume 13, Number 6 : pp. 469–474 The advantages and disadvantages of process-based measures of health care quality HAYA R. RUBIN 1 , PETER PRONOVOST 2 AND GREGORY B. DIETTE 3 1 Associate Professor, Departments of Medicine, Health Policy & Management, and Epidemiology, and Director, Quality of Care Research, The Johns Hopkins Medical Institutions, Baltimore, MD 2 Assistant Professor, Departments of Anesthesiology & Critical Care Medicine, Surgery, and Health Policy & Management, The Johns Hopkins Medical Institutions, Baltimore, MD and 3 Assistant Professor, Departments of Medicine and Epidemiology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA Abstract As consumers, payers, and regulatory agencies require evidence regarding health care quality, the demand for process of care measures will grow. Although outcome measures of quality represent the desired end results of health care, validated process of care measures provide an important additional element to quality improvement efforts, as they illuminate exactly which provider actions could be changed to improve patient outcomes. In this essay, we discuss the advantages and disadvantages of process measures of quality, and outline some practical strategies and issues in implementing them. Keywords: outcomes, performance improvement, quality Quality of health care has become a national and international six aims of being effective, safe, patient-centered, timely, efficient, and equitable [4]. Whereas the aims of effectiveness policy issue. Decades of study indicate that quality of care needs improvement all over the world, and therefore sen- and safety of health care are nearly universal, societies and cultures around the world differ more in how much they timent has grown that public disclosure of information about quality of care should be one component of clinical gov- emphasize the additional aims of patient-centeredness, time- liness, efficiency, and equity. Process of care measures of ernance [1]. The United States government has developed the Agency for Healthcare Research and Quality (AHRQ) quality assess the degree to which providers perform health care processes demonstrated to achieve the desired aims and and the National Quality Forum to promote the development and reporting of quality measures [2]. the degree to which they avoid processes that avert the desired aims. Readers of this journal are well aware that more than thirty years ago, Donabedian proposed that we can measure the Public agents and payers’ ultimate concern rests with providers’ impact on patient outcomes, and most of their quality of health care by observing its structure, its processes, and its outcomes [3]. The Institute of Medicine (IOM) in the measures of quality to date have focused on this. For example, the Center for Medicare and Medicaid Services (CMS formerly US has defined health care quality as ‘the degree to which health services for individuals and populations increase the
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