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The Top 7 Outcomes Measures and 3 Measurement Essentials

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Outcomes improvement can’t happen without effective outcomes measurement. Given the healthcare industry’s administrative and regulatory complexities, and the fact that health systems measure and report on hundreds of outcomes annually, this blog adds much-needed clarity by reviewing the top seven outcome measures, including definitions, important nuances, and real-life examples:

Mortality
Readmissions
Safety of care
Effectiveness of care
Patient experience
Timeliness of care
Efficient use of medical imaging

CMS used these exact seven outcome measures to calculate overall hospital quality and arrive at its 2016 hospital star ratings. This blog also reiterates the importance of outcomes measurement, clarifies how outcome measures are defined and prioritized, and recommends three essentials for successful outcomes measurement:

Transparency
Integrated care
Interoperability

Veröffentlicht in: Gesundheitswesen

The Top 7 Outcomes Measures and 3 Measurement Essentials

  1. 1. The Top 7 Outcome Measures and 3 Measurement Essentials ― ANN TINKER
  2. 2. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Outcome Measurement The healthcare industry is riddled with administrative and regulatory complexities that make it difficult for health systems to achieve the Triple Aim of healthcare. Complexities in outcomes improvement are particularly challenging, as health systems measure and report on hundreds of outcomes annually.
  3. 3. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Outcome Measures Defined Outcome measures (mortality, re- admission, patient experience, etc.) are the quality and cost targets healthcare organizations are trying to improve. “…change in the health of an individual, group of people, or population that is attributable to an intervention or series of interventions.” — World Health Organization
  4. 4. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Outcome Measures Defined Outcome measures are frequently reported to the government, commercial payers, and organizations that report on quality, such as The LeapFrog Group— a national nonprofit that evaluates and reports U.S. hospital safety and quality performance. LeapFrog’s work centers on “increasing transparency among health care providers in order to reduce the estimated 440,000 annual deaths from hospital errors, accidents, and injuries.”
  5. 5. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Why Measuring Outcomes Is Important The ultimate goal of measuring, reporting, and comparing health outcomes is to achieve the Triple Aim of healthcare: Institute for Healthcare Improvement (IHI): Triple Aim Improve the patient experience of care. Improve the health of populations. Reduce the per capita cost of healthcare.
  6. 6. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Why Measuring Outcomes Is Important The organization behind the Triple Aim—the Institute for Healthcare Improvement (IHI)—is dedicated to outcomes improvement. IHI describes measurement as “a critical part of testing and implementing changes. Measures tell a team whether the changes they are making actually lead to improvement.” Healthcare organizations, motivated by the Triple Aim, measure outcomes for many reasons…
  7. 7. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Why Measuring Outcomes Is Important Healthcare organizations, motivated by the Triple Aim, measure outcomes for many reasons: • Reveal areas in which interventions could improve care. • Identify variations of care. • Provide evidence about interventions that work best for certain types of patients under certain circumstances. • Compare the effectiveness of various treatments and procedures.
  8. 8. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Outcome Measures Are Driven by National Standards and Financial Incentives Outcome measures are primarily defined and prioritized by national organizations, including CMS, The Joint Commission (TJC), and the National Association for Healthcare Quality (NAHQ). Health systems target outcome measures based on state and federal government mandates, accreditation requirements, and financial incentives.
  9. 9. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Outcome Measures Are Driven by National Standards and Financial Incentives Although outcomes and targets are defined at the national level, health systems might set more aggressive targets. Meeting and exceeding national targets benefits not only quality of care, but also marketing and contracting.
  10. 10. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Outcome Measures Are Driven by National Standards and Financial Incentives TJC is a regulatory body that accredits health systems and has national standards for quality measures that are “developed with input from healthcare professionals, providers, subject matter experts, consumers, government agencies (including CMS) and employers.”
  11. 11. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Outcome Measures Are Driven by National Standards and Financial Incentives New standards must meet strict requirements: • Relate to patient safety or quality of care. • Positively impact health outcomes. • Meet or surpass law and regulation. • Can be accurately and readily measured.
  12. 12. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Outcome Measures Are Driven by National Standards and Financial Incentives Reporting and accreditation entities have processes in place to normalize outcomes data to account for context, which is key when it comes to reporting. It’s easy to take data out of context. Using fall rates as an example, if a small, 10-bed hospital sees ten patients in one month and one patient falls, then their fall rate is high (10 percent).
  13. 13. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Outcome Measures Are Driven by National Standards and Financial Incentives CMS uses outcome measures to calculate overall hospital quality. In a recent report, CMS explained how it arrived at its 2016 hospital star ratings. CMS grouped outcome measures into seven categories weighted by importance: • Mortality (22%) • Safety of care (22%) • Readmissions (22%) • Patient experience (22%) • Effectiveness of care (4%) • Timeliness of care (4%) • Efficient use of medical imaging (4%)
  14. 14. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. The Top Seven Outcome Measures Explained There are hundreds of outcome measures, ranging from changes in blood pressure in patients with hypertension to patient-reported outcome measures (PROMs). The seven outcome measures CMS uses to calculate hospital quality are some of the most common in healthcare:
  15. 15. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. The Top Seven Outcome Measures Explained There are hundreds of outcome measures, ranging from changes in blood pressure in patients with hypertension to patient-reported outcome measures (PROMs). The seven outcome measures CMS uses to calculate hospital quality are some of the most common in healthcare:
  16. 16. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Mortality (life expectancy) The Top Seven Outcome Measures Explained Mortality is an essential population health outcome measure. For example, MultiCare Health System’s initiative to improve the care, cost, and experience of pneumonia patients, reduced the pneumonia mortality rate by 28 percent. 1
  17. 17. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Readmissions The Top Seven Outcome Measures Explained Readmission following hospitalization is a common outcome measure. Readmission is costly (and often preventable). For example, MultiCare Health System reduced pneumonia readmissions by 23 percent by building evidence-based order sets, assigning a team of social workers to improve patient follow-up and communica- tion, and deploying an analytics application to provide near real-time feedback on compliance and performance. 2
  18. 18. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Safety of Care The Top Seven Outcome Measures Explained Safety of care outcome measures pertain to medical mistakes. Skin breakdown and hospital acquired infections (HAIs) are common safety of care outcome measures: 3 Happens when pressure decreases blood flow to the skin. A skin assessment tool can be used to reduce skin breakdown. Patients with skin breakdown are at a higher risk of infection. Skin breakdown Caused by viral, bacterial, and fungal pathogens. Texas Children’s identified evidence-based bundles to reduce HAIs in children and decreased HAIs by 35 percent. HAIs
  19. 19. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Patient Experience The Top Seven Outcome Measures Explained Readmission following hospitalization is a common outcome measure. Readmission is costly (and often preventable). For example, MultiCare Health System reduced pneumonia readmissions by 23 percent by building evidence-based order sets, assigning a team of social workers to improve patient follow-up and communica- tion, and deploying an analytics application to provide near real-time feedback on compliance and performance. 4
  20. 20. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Effectiveness of Care The Top Seven Outcome Measures Explained Effectiveness of care outcome measures evaluate two things: • Compliance to best practice care guidelines. • Achieved outcomes (e.g. lower readmission rates for heart failure patients). 5 It’s important to track clinician compliance to care guidelines. It’s equally important to monitor treatment outcomes and alert clinicians when care guidelines need to be reviewed.
  21. 21. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Timeliness of Care The Top Seven Outcome Measures Explained Timeliness of care outcome measures assess patient access to care. For example, a health system working to design a more efficient and accurate system for assessing sepsis developed an analytics platform to track the timeliness of care delivery, including several interventions: lactate tests, blood cultures, antibiotics, and central venous pressure (CVP). 6
  22. 22. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Efficient Use of Medical Imaging The Top Seven Outcome Measures Explained The efficient use of medical imaging is an increasingly important outcome measure. 7 “Medical imaging plays a central role in the global healthcare system as it contributes to improved patient outcome and more cost-efficient healthcare in all major disease entities.” — European Science Foundation
  23. 23. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Process Measures Are Equally Important Achieving outcomes is important, but the process by which we achieve outcomes is equally important. Process measures capture provider productivity and adherence to standards of recommended care. For example, if a health system wants to reduce the incidence of skin breakdown, then it might implement the process measure of performing a risk assessment using the Barden Scale for reducing pressure ulcer risk in all the appropriate units in the hospital.
  24. 24. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Process Measures Are Equally Important The following outcome and process measures illustrate how health systems improve outcomes by improving processes: Can reduce heart failure readmission rates. Outcome Measure Conducting a medication reconciliation system check with heart failure patients at the time of discharge. Process Measure
  25. 25. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Process Measures Are Equally Important The following outcome and process measures illustrate how health systems improve outcomes by improving processes: Can reduce fall rates. Outcome Measure Performing a fall risk assessment on a patient at the time of admission Process Measure
  26. 26. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Process Measures Are Equally Important The following outcome and process measures illustrate how health systems improve outcomes by improving processes: Can prevent skin breakdown. Outcome Measure Using a skin assessment tool. Process Measure [See Also: Why Process Measures Are Often More Important Than Outcome Measures in Healthcare]
  27. 27. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Three Essentials For Successful Outcomes Measurement Health systems’ ultimate goal is to improve patient outcomes. But outcomes improvement can’t happen without effective outcomes measurement. As health systems work diligently to achieve the Triple Aim of healthcare, they need to prioritize three outcomes measurement essentials: transparency, integrated care, and interoperability.
  28. 28. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Transparency The Top Seven Outcome Measures Explained The healthcare industry is on a journey to outcomes transparency. Patients want outcomes data so they can make educated decisions about their healthcare. Quality reporting organizations, such as The LeapFrog Group, evaluate and report U.S. hospital safety and quality performance. Patients want reassurance they’re receiving the best care for the lowest cost—publicly reported outcomes help. 1
  29. 29. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Integrated Care The Top Seven Outcome Measures Explained The industry is also shifting toward integrated care—we aren’t just treating a hip anymore; we’re treating the whole person. A key to integrated care is helping patients with transitions―easing them from the ER, to surgery, to inpatient care, to rehab, and back to a steady, normal state. Transitional points of care are critical for managing consistency of care and providing the right care in the right setting at the lowest cost. 2
  30. 30. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Interoperability The Top Seven Outcome Measures Explained Sharing data between departments within an integrated system is another important component. Outcomes measurement and improvement depends on the system’s ability to share data across clinicians, labs, hospitals, pharmacies, and other staff, departments, and settings. EDWs improve interoperability by integrating data and providing a single source of truth. 2
  31. 31. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. The Triple Aim: Outcomes measurement should always tie back to the Triple Aim (improve the patient experience, improve the health of populations, and reduce costs) so we’re not just reporting numbers. The Ultimate Goal of Outcomes Measurement Institute for Healthcare Improvement (IHI): Triple Aim The focus should be on quality and improving the care experience at the lowest cost. We don’t want to become so obsessed with numbers that we forget our Triple Aim goal.
  32. 32. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. For more information: “This book is a fantastic piece of work” – Robert Lindeman MD, FAAP, Chief Physician Quality Officer
  33. 33. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. More about this topic Why Process Measures Are Often More Important Than Outcome Measures in Healthcare Tom Burton, Product Development, SVP Improving Healthcare Outcomes: Keep the Triple Aim in Mind Michael Barton, Engagement Executive, VP - Tracy Vayo, Director, Knowledge Development Kathleen Merkley, Clinical Improvement, VP Why Most Analytic Applications Will Never Be Able to Significantly Improve Healthcare Outcomes Dan Soule, Vice President of Product Management Quality Improvement in Healthcare: Where is the Best Place to Start? Eric Just Eric Just, Technology, VP 6 Steps for Implementing Successful Performance Improvement Initiatives in Healthcare Report) Bobbi Brown, VP of Financial Engagement - Leslie Falk, Customer Engagement, VP Link to original article for a more in-depth discussion. The Top 7 Outcome Measures and 3 Measurement Essentials
  34. 34. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Ann Tinker joined Health Catalyst in June of 2012 as a Vice President for Customer Engagements. Prior to coming to Health Catalyst, she worked for GE Healthcare IT on the GE/Intermountain Healthcare partnership product called Qualibria as a Product Manager and Customer liaison. Ann worked PRN (on- call) for LDS Hospital in the Post Anesthesia Care Unit (PACU) as a staff RN for the past 6+ years. Before GE Ann was employed at 3M HIS business based in Salt Lake City working in a variety of positions from sales support, implementation, development, marketing and product management for both US and International products and prior to then worked for Intermountain Healthcare for 10+ years in Critical Care and Nursing Administration. Ann has a bachelor’s degree in nursing from Brigham Young University and a Masters from University of Washington. Other Clinical Quality Improvement Resources Click to read additional information at www.healthcatalyst.com

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