Outcome measure is a change in the health of an individual, group of people or population that is attributable to an intervention or series of interventions.” Outcome measures are the quality and cost targets healthcare organizations are trying to improve. Some Patient Outcome Examples are mortality rate, birth rate, readmission, patient experience etc. An outcome measure is the result of a test that is used to objectively determine the baseline function of a patient at the beginning of treatment. Once treatment has commenced, the same instrument can be used to determine progress and treatment efficacy.
Outcome measures are driven by national standards and financial incentives but that’s not all. They are also primarily defined and prioritized by national organizations and health systems target outcome measures based on state and federal government mandates, accreditation requirements, 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.
There are regulatory bodies that accredit 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.” 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.
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%)
There are steps that need to be taken to ensure the successful measurement or outcomes. Health systems’ ultimate goal is to improve patient outcomes. But outcomes improvement can’t happen without effective outcomes measurement. The three main steps to be taken are:
Transparency: 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.
Integrated Care: The industry is also shifting toward integrated care—we aren’t just treating a hip anymore; we’re treating the whole person. A key component of integrated care is helping patients with transitions; easing patient transitions from the ER, to surgery, to inpatient care, to rehab, and, ultimately, 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.
Interoperability: 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. Improving critical care transitions through integrated care and seamlessly exchanging data through interoperability are essential ingredients for better outcomes measurement. For example, as heart failure patients are discharged (depending on the risk stratification), it’s critical for them to see a cardiologist or primary care physician as quickly as possible. Otherwise, they are discharged and have a higher risk of being readmitted.
While focusing on achieving outcome measurement improvements, it’s also important to focus on process measurement. If health systems are too focused on an outcome, then they lose sight of the process. 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 for reducing pressure ulcer risk in all the appropriate units in the hospital.