Types of Measurement
- 1. Introduction and Outline of the 3 Types of Measurement Jess Morritt
- 2. Presentation Outline Jade will discuss constructing a measurement Astrid will discuss interpreting quality measurement Alex will discuss how compliance is being measured in the real world setting
- 3. Donabedian’s Model of Measures Structure Physical equipment and facilities Process How the system works Outcome The final product, results
- 4. Structure Measures Relate to characteristics associated with a health care setting Broad list of variables reflecting the setting or system in which care is delivered
- 5. Structure Measures Advantages Disadvantages Strongly related to Focuses on a small outcomes number of variables Can be assessed easily Most structural and inexpensively measures can only be assessed in observational studies Many structural measures are not readily actionable
- 6. Process Measures Evaluate if appropriate actions were taken for an intended outcome and how well these actions were performed to achieve a given outcome Describe the care that patients actually receive and are routinely used as quality indicators
- 7. Process Measures Advantages Disadvantages High level of evidence Must be able to supporting their accurately identify effectiveness eligible patient Reflect the care that Ensuring the right patients actually receive denominator implies the Generally actionable need for clinical data and link directly to and may be labor quality improvement intensive activities
- 8. Outcome Measures Seek to capture changes in the health status of patients following the provision of a set of health care processes Describe the patient’s condition, behavior and response Provide an indirect measure of the overall quality of an organisation
- 9. Outcome Measures Advantages Disadvantages Most consider patient Relates to sample size outcomes the “bottom line” Measurement alone may improve outcomes
- 10. Summary of Measures Historically, quality measurement has focused primarily on outcomes Now, structure and process measures are important to improve outcomes
- 11. Example If you were concerned about reducing prenatal mortality, you might look at: Type of Example Measure Structure •Availability of physicians and/or midwives providing obstetrical care. Process •Percent of mothers receiving prenatal care prior to 12 weeks gestation •Percent of mothers taking prenatal vitamins •Percent of smoking mothers counseled to quit Outcome •Neonatal mortality rate •Pre-maturity rate
- 12. PPE Example If you were concerned about PPE compliance, you might look at: Type of Example Measure Structure •Availability of staff •Availability of PPE equipment Process •Percent of staff receiving PPE training •Percent of staff complying with PPE Outcome •What is the hospital acquired infection rate
Editor's Notes
- #2: Image sourced from:http://www.searchmarketinggurus.com/.a/6a00d8341bfb1a53ef01157026affc970b-800wi
- #4: StructurePhysical equipment and facilitiesProcessHow the system worksOutcomeThe final product, resultsVarkey, P. (Ed.). (2010). Medical quality management: Theoryandpractice. Sudbury, MA: Jonesand Bartlett Publishers.Measurement: Process and Outcome Indicators. (2005). Retrieved January 11, 2012, from http://patientsafetyed.duhs.duke.edu/module_a/measurement/measurement.htmlImage sourced from:http://www.blog.republicofmath.com/wp-content/uploads/2010/12/tape_measure.jpg
- #5: Relate to characteristics associated with a health care setting, including its policies and proceduresStructural measures include a broad list of variables reflecting the setting or system in which care is deliveredVarkey, P. (Ed.). (2010). Medical quality management: Theoryandpractice. Sudbury, MA: Jonesand Bartlett Publishers.Birkmeyer, J., Dimick, J., & Birkmeyer, N. (2005). Measuring the Quality of Surgical Care, Structure, Process, or Outcomes. Retrieved January 11, 2012, from http://www.surgicalcomplication.info/PDF/2004BJD.pdfImage sourced from:http://www.engineersinc.co.uk/pics/structural-analysis2.jpg
- #6: AdvantagesMany of these variables are strongly related to outcomesStructural variables can be assessed easily and inexpensively, often with administrative dataDisadvantagesFocuses on a small number of variables and outcomes measuresMost structural measures can only be assessed in observational studiesIn contrast to process measures, many structural measures are not readily actionable, which limit their ultimate effectiveness as a means toward quality improvementVarkey, P. (Ed.). (2010). Medical quality management: Theoryandpractice. Sudbury, MA: Jonesand Bartlett Publishers.Birkmeyer, J., Dimick, J., & Birkmeyer, N. (2005). Measuring the Quality of Surgical Care, Structure, Process, or Outcomes. Retrieved January 11, 2012, from http://www.surgicalcomplication.info/PDF/2004BJD.pdf
- #7: Evaluate if appropriate actions were taken for an intended outcome and how well these actions were performed to achieve a given outcomeProcess variables describe the care that patients actually receive and are routinely used as quality indicatorsVarkey, P. (Ed.). (2010). Medical quality management: Theoryandpractice. Sudbury, MA: Jonesand Bartlett Publishers.Birkmeyer, J., Dimick, J., & Birkmeyer, N. (2005). Measuring the Quality of Surgical Care, Structure, Process, or Outcomes. Retrieved January 11, 2012, from http://www.surgicalcomplication.info/PDF/2004BJD.pdfImage sourced from:http://3forward.com/wp-content/uploads/2011/04/process.jpg
- #8: AdvantagesHigh level of evidence supporting their effectiveness (often randomised clinical trials), some process measures have very large potential benefitsReflect the care that patients actually receive and may be perceived by providers as “fairer” measures of quality than structural measuresGenerally actionable and link directly to quality improvement activitiesDisadvantagesMust be able to accurately identify eligible patient Ensuring the right denominator implies the need for clinical data and may be labor intensive, a practical limitation of process measurementVarkey, P. (Ed.). (2010). Medical quality management: Theoryandpractice. Sudbury, MA: Jonesand Bartlett Publishers.Birkmeyer, J., Dimick, J., & Birkmeyer, N. (2005). Measuring the Quality of Surgical Care, Structure, Process, or Outcomes. Retrieved January 11, 2012, from http://www.surgicalcomplication.info/PDF/2004BJD.pdf
- #9: Seek to capture changes in the health status of patients following the provision of a set of health care processes and include the costs of delivering the processesShould describe the patient’s condition, behavior and responseProvide an indirect measure of the overall quality of an organisationVarkey, P. (Ed.). (2010). Medical quality management: Theoryandpractice. Sudbury, MA: Jonesand Bartlett Publishers.Birkmeyer, J., Dimick, J., & Birkmeyer, N. (2005). Measuring the Quality of Surgical Care, Structure, Process, or Outcomes. Retrieved January 11, 2012, from http://www.surgicalcomplication.info/PDF/2004BJD.pdfImage sourced from:http://tennisassist.com/wp-content/uploads/iStock_000004996421XSmall.jpg
- #10: AdvantagesMost consider patient outcomes the “bottom line” Measurement alone may improve outcomesDisadvantagesRelates to sample sizeBirkmeyer, J., Dimick, J., & Birkmeyer, N. (2005). Measuring the Quality of Surgical Care, Structure, Process, or Outcomes. Retrieved January 11, 2012, from http://www.surgicalcomplication.info/PDF/2004BJD.pdf
- #11: Historically, quality measurement has focused primarily on outcomes. Today, structure and process measures provide important insights, illuminating which areas to address in order to improve outcomes. Structure and process provide direct measures of quality and thus yield more sensitive measures of quality, which can direct clinicians to the most effective ways to improve patient care. Varkey, P. (Ed.). (2010). Medical quality management: Theoryandpractice. Sudbury, MA: Jonesand Bartlett Publishers.
- #12: Measurement: Process and Outcome Indicators. (2005). Retrieved January 11, 2012, from http://patientsafetyed.duhs.duke.edu/module_a/measurement/measurement.html
- #13: Adapted from:Measurement: Process and Outcome Indicators. (2005). Retrieved January 11, 2012, from http://patientsafetyed.duhs.duke.edu/module_a/measurement/measurement.html