Outcomes-Based Accreditation

History

Florence Nightingale was the first to study health outcomes by measuring mortality and infection rates in British military hospitals during the Crimean War. In the early 20th century, a pioneering physician at the Massachusetts General Hospital in Boston, Ernest Codman, proposed an end-results system to examine patient outcomes of surgical procedures. At the time, Codman's idea was viewed as radical and against the medical establishment. Building on Codman's idea, Avedis Donabedian developed a framework for quality assessment that included structure, process, and outcomes. Structure refers to the structural characteristics of healthcare organizations, such as the number of certified staff, equipment, and medical technologies; process includes all the processes involved in providing care to the patient; and outcomes are the results of the care rendered by the provider.

Historically, accreditation reviews were primarily based on structural features since they were easy to measure; however, recently there has been a movement to further examine process and outcomes measures that give a more comprehensive view of patient care quality and enable consumers and purchasers to make informed healthcare decisions. By using the framework of Donabedian and Codman's end-result system, organizations such as the National Committee for Quality Assurance (NCQA) and the Joint Commission have started using outcomes to accredit health plans and healthcare facilities.

Accrediting Organizations

The NCQA, a private, nonprofit organization, is dedicated to improving healthcare quality by accrediting and certifying a wide range of healthcare plans through its set of performance measures known as the Health Plan Employer Data and Information Set (HEDIS). The mission of the NCQA is to provide information to purchasers and consumers on the quality of care of managed-care organizations that will allow them to make informed purchasing decisions. Beginning with HEDIS 3.0, the NCQA started to make progress by including the outcomes measures of patient function and satisfaction in its evaluation process. The major barrier to the initial implementation of outcomes measures in HEDIS was the lack of information technology infrastructure to capture these measurements. NCQA's report A Road Map for Information Systems: Evolving Systems to Support Performance Measurements outlined the upgrades needed to meet the demand of outcomes measurement.

The Joint Commission, an independent, private, nonprofit organization, accredits and evaluates approximately 15,000 healthcare organizations and programs in the United States. In 1997, the ORYX Performance Measurement System for the first time integrated performance measures into the Joint Commission's accreditation process. Beginning in July 2002, the first core measures on accredited hospitals were collected.

The purpose of ORYX is to link patient outcomes with accreditation to make the accreditation process more valuable while focusing on patient-centered care. ORYX is used as a supplement to the standards-based survey by continuously monitoring the performance of organizations, facilitating continuous quality improvement, and targeting the on-site survey. To meet accreditation requirements, some healthcare organizations must submit data on a specified minimum number of measures to a performance measurement system or the Joint Commission, and these data are reviewed by the surveyor(s) at the on-site survey. Using data reported from the organization's core measures, the surveyors assess the performance improvement activities of the organization during the on-site survey.

...