QuPS.org Performance Measures provides thumbnail sketches with links to more in-depth information resources for healthcare performance measures and the organizations that develop them.
The primary goal of this website is to make this complex information understandable. Website organization includes the following 4 sections:
- • Organizations Behind Performance Measures | Measurement Sets
- • Performance Measures | Measurement Sets
- • Crosswalk of Performance Measures by Clinical Topic
- • Concepts (e.g. Coding) Underlying Performance Measures
Please Select one of the topics within the 4 sections in the left navigation column.
PERFORMANCE MEASURES DEFINITIONS
Performance Measures provide a means of measuring Quality of healthcare.1 While several quality organizations have issued exhaustive statements regarding the principles or classifications involved with Performance measures, the classification utilized in this website is a simplified perspective of the five domains identified by AHRQ's National Quality Measurement Clearinghouse (NQMC).2 While the validity of these 5 domains of measurement (Access, Outcome, Patient Experience, Process, Structure) provide a valid classification, most identified performance measures in use in 2006 lie within the Outcomes and Process domains. Outcomes and process measures comprise the predominate quality measures discussed in these web pages.
Process Measures are garnered from data that demonstrate the implementation of activities, including the products of activities and indicators of services that are provided. There is a numerator and a denominator that is defined as part of the measure, and the indicator(s) of the process is(are) monitored on every eligible patient. Process measures are usually reported in aggregate over a defined patient population as proportions, averages, or rates. As currently employed in the United States, process measures assess adherence to recommendations for clinical practice based on evidence or consensus, and data are almost always generated from hospital administrative databases, using HIPAA Standard codes. Process measures are usually reported by facility or groups of providers, since most process measures identify specific areas of system-related care that may require improvement rather than identifying individual provider performance.
Outcome Measures assess and measure specifically defined endpoint(s) reflecting the health state of a patient. A numerator and a denominator are defined as part of the measure. Outcomes are usually reported in aggregate over a defined patient population as proportions, averages, or rates, based on data that is reported for all eligible patients. Since incidence of outcomes vary according to recognized clinical characteristics of patients (e.g. age, gender), risk adjustment for multiple clinical characteristics may be included, so as to account for reporting of disparate patient groups by individual providers or facilities. Data may be generated from hospital administrative databases, using HIPAA Standard codes, or from clinical databases designed to capture specifically defined events. Outcome reports, which require data from all eligible patients in the denominator, are typically reported retrospectively quarterly or annually.
Adverse Event Measures are special types of outcome events that are not included in this section as Performance Measures. They are addressed in depth on this website in the section on Medical Errors.
Adverse events require prospective monitoring by healthcare providers of all eligible patients, and each event is measured and reported for individual patients as it is detected. Except for the States of Tennessee and New York who monitor adverse events by reporting of E-codes for specifically-defined ICD-9 diagnostic groups or procedures, administrative databases have no primary role in the identification process, which generally falls to individual healthcare providers who witness delivery of healthcare. Examples of adverse event reporting programs targeted to specific tasks include U.S. Pharmacopeia's MedMARx program, the USP/ISMP-sponsored Medication Error Reporting Program (MERP), the CDC's National Nosocomial Infection Surveillance System (NNIS), and the Toxic Exposure Surveillance System (TESS), sponsored by the American Association of Poison Control Centers. The only broad-based adverse event reporting programs are maintained by States, although federal legislation calling for voluntary reporting of adverse events to Patient Safety Organizations may increase reporting participation over time.3 Results are generally reported in aggregate, if they are reported at all, and reporting is done according to standards established by the State that collects them. There is no reporting of a denominator for these reported measures for any of the 13 States that currently report adverse events, except by inference.
1 The Institute of Medicine's definition of quality of care is "the degree to which health care services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge." A quality measure is a mechanism that enables the user to quantify the quality of a selected aspect of care by comparing it to a criterion.
2 The AMA, JCAHO, and NCQA have published a consensus statement on principles of performance measures [PDF].
3 The Patient Safety and Quality improvement Act of 2005 [P.L. 109-41] that was signed into law on July 29, 2005, establishes voluntary, confidential, and non-discoverable reporting of adverse events / medical errors to non-federally funded Patient Safety Organizations, which will function as the the entities through which voluntary reporting is channeled.
Healthcare quality performance measures that are defined by public (CMS, AHRQ, CDC) or private quality organizations are predominantly outcomes and process measures. They do not include ‘adverse events’ or ‘medical errors’ that are addressed in depth on this website in the section on Medical Errors. Most of the 200+ performance measures that have been endorsed by the National Quality Forum (NQF) through 2006 measure processes of care, but outcome measures are also present. Several non-NQF-endorsed measures that are assessed by AHRQ's Quality Indicators are outcome measures that pertain to carefully stipulated patient populations. Many more performance measures lack NQF endorsement, and may receive endorsement as NQF projects and processes evolve.
Quality performance measurement is evolving, and new performance measures will necessarily appear and old ones will change. Increasingly performance measures will reflect national standards and require endorsement by the NQF. Measures addressing patients' satisfaction and/or experience with healthcare, including access to care, will increasingly receive NQF endorsement.