Performance measures.

Includes both measures of patient perspectives on care, clinical quality, and patient outcomes.

• Measures of patient perspectives include patient assessment and satisfaction with their access to and interactions with the care delivery system (e.g., waiting times, information received from providers, choice of providers).

• Measures of clinical quality are specific quantitative indicators to identify whether the care provided conforms to established treatment goals and care processes for specific clinical presentations. Clinical quality measures generally consist of a descriptive statement or indicator (e.g., the rate of beta blocker usage after heart attack, the 30-day mortality rate following coronary artery bypass graft surgery), a list of data elements that are necessary to construct and/or report the measure, detailed specifications that direct how the data elements are to be collected (including the source of data), the population on whom the measure is constructed, the timing of data collection and reporting, the analytic models used to construct the measure, and the format in which the results will be presented. Measures may also include thresholds, standards, or other benchmarks of performance (IOM, 2002).

• Measures of patient outcomes include mortality, morbidity, and physical and mental functioning.

Providers.

Refers to both institutional providers of health care services (e.g., health plans, HMOs, hospitals, nursing homes) and clinicians (e.g., physicians, nurse practitioners, nurses, physician assistants).


Quality.

The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge (IOM, 1990).

Quality aims.

Descriptive elements of health care delivery goals, specifically:

1. Safe—avoiding injuries to patients from the care that is intended to help them.

2. Effective—providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit (avoiding underuse and overuse, respectively).

3. Patient-centered—providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.

4. Timely—reducing waits and sometimes harmful delays for both those who receive and those who give care.

5. Efficient—avoiding waste, including waste of equipment, supplies, ideas, or energy.



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