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Quality Indicators

Healthcare quality indicators are tools to measure and monitor the quality of care. Quality indicators are used to determine how well a healthcare system is performing and how it can be further improved. Because poor healthcare quality can adversely affect people's lives and lead to unnecessary healthcare expenditures, quality measurement is important.

Definition

Healthcare quality indicators are the instruments and methods for quantitatively assessing clinical processes and/or patient outcomes. They are used to document the quality of care delivered by providers, evaluate patient outcomes and institutional performance, make comparisons over time and between providers, inform and help purchasers and patients make wise decisions in selecting providers, support accountability and quality improvement efforts, and create transparency in the healthcare system.

Based on the published literature, some of the key characteristics of healthcare quality indicators are as follows: They are based on agreed definitions, described exhaustively, are highly specific and sensitive, are valid and reliable, discriminate well, are relevant, permit useful comparisons, and are evidence based. Quality indicators should be explicit statements of structure, process, or outcome dimensions.

Quality indicators should be developed in the planning and development phase. The planning phase should consist of choosing the clinical area for evaluation and organizing the measurement team. The development phase should comprise providing an overview of existing evidence and practice, selecting clinical indicators and standards, designing the measure specification, and performing pilot tests. The development of quality indicators should be closely tied to both the definition and efforts to improve the quality of care.

Quality indicators can be categorized based on the type of healthcare provided (preventive, chronic, or acute); function (screening, diagnosis, treatment, or follow-up); modality (history, physical examination, laboratory/radiological study, medication); whether they are generic or disease specific, and whether they are rate based or sentinel.

Overview

Recent reports have highlighted the major deficiencies in the U.S. healthcare system. The National Academy of Sciences, Institute of Medicine's 2000 report, To Err Is Human, estimated that between 48,000 and 98,000 people die each year in American hospitals from preventable medical errors. And another study (Barbara Starfield's) estimated that 225,000 deaths occur each year in the nation as the result of iatrogenic causes-unnecessary surgeries, medication errors, other hospital errors, hospital-acquired infections, and adverse effects of medications.

Studies have also shown that healthcare quality in the United States varies greatly among providers and across geographic regions. Healthcare often does not meet professional standards, with most adults in the nation only receiving about half of the recommended care for common acute and chronic conditions as well as preventive services. Additionally, studies have shown that the quality of care varies according to where an individual lives in the country. As a result, there remains significant room for quality improvement across all states.

Variation in healthcare quality is not unique to the United States. Many national and international studies on the quality of care have found that the care provided in most countries is substandard. Furthermore, many countries lack performance evaluation systems to measure the quality of care. Extensive research demonstrates that quality of care does not depend on the payment system. Even countries with single-payer systems have problems with quality. Additionally, the level of quality does not appear to depend on the level of healthcare expenditures. For example, the United States has the highest healthcare expenditures per capita, but it still does not have the best measurable outcomes. Overall, there remains a general lack of investment in measuring the quality of care.

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