What are healthcare quality measures?
Healthcare quality measures are criteria to measure healthcare quality set and continuously developed by government agencies (e.g., the Centers for Medicare and Medicaid Services), private non-profit (e.g., National Committee for Quality Assurance) or for-profit companies (e.g., U.S. News and World Report).
Quality measurement in healthcare is the process of using data to evaluate the performance of health plans and healthcare providers against recognized quality standards.
Types of quality measures
- Structural measures: focus on the infrastructure of the healthcare setting (e.g., staffing, skills, policies, resources, protocols)
- Process measures: look at if providers consistently give patient services that are consistent with recommended guidelines (e.g., regularly checking feet of diabetes patients for wounds)
- Outcome-based measures: evaluate patient’s health status as result of the care
- Patient experience measures: based on patient feedback; includes interpersonal aspects (e.g., waiting times)
What are healthcare quality indicators?
Measures of healthcare quality that make use of readily available hospital inpatient administrative data are known as quality indicators.
They are standardized evidence-based measures of healthcare quality that can be used with readily-available data to measure and track clinical performance and outcome.
Types of quality indicators by the Agency for Healthcare Research and Quality (AHRQ)
- Prevention quality indicators: ambulatory care sensitive conditions for which good outpatient care and early intervention can prevent hospitalization and complications (e.g., diabetes long-term complication admission rate, hypertension admission rates)
- Inpatient quality indicators: information about the quality of care in the hospital; examples:
- Provider-level volume indicators
- Mortality indicators for inpatient procedures
- Mortality indicators for inpatient conditions
- Utilization indicators
- Patient safety indicators: information on potentially avoidable safety events
- Pediatric quality indicators: quality of care for children inside hospitals
What is healthcare quality improvement?
Healthcare quality improvement (QI) stands for systematic and continuous actions that lead to measurable improvement in healthcare services and the health status of targeted patient groups.
The 4 principles of quality improvement
A successful QI program incorporates 4 key principles:
- It comes in systems and processes
- It focuses on patients
- It focuses on being part of the team
- It focuses on the use of data
Features of an effective QI system
To make improvements, an organization needs to understand its own delivery system and key processes. QI can assume many forms, but is most effective if it’s individualized to meet the needs of a specific organization’s health service delivery system.
- Focus on 2 key questions:
- What is done (what care is provided)
- How is it done (processes, when, where, who)
- Team-based approach (no one person knows all dimensions of an issue; the combination of the team members’ knowledge, skills, experience and perspectives lead to lasting improvements)
- Data-driven (describe how well current systems are working)
- Using quantitative methods (leads to measurable data)
- Qualitative methods to collect data with descriptive characteristics
Nurses’ role in quality improvement
Nurses are directly involved in almost all aspects of hospital quality, including
- Patient care; monitoring and assessing patients and performing immediate interventions to reduce risk or prevent medical complications
- Bedside and medication management
- Assistance with surgeries and other major operations
- Data collection
- Reporting and more.
Therefore, nurses play a critical role when it comes to improving hospital quality.
What is the healthcare quality improvement act?
The Health Care Quality Improvement Act (HCQIA) of 1986 is a United States federal statute that was established to improve the quality of medical care nationwide.
One of the primary motivations for its enactment was the growing concern about the ability to restrict incompetent physicians from moving from state to state without disclosure or discovery of their previous inadequate performance or malpractice history.
Among other regulations, it includes the mandatory creation of a national database storing information about healthcare professionals, immunity from monetary liability for the participants of professional peer review actions taken to improve healthcare quality, and encouragement for facilities to restrict or revoke privileges for providers found to practice substandard.
Are there healthcare quality jobs?
There are many options to put a specific focus on healthcare quality in the healthcare career field, including:
- Patient safety officer
- Compliance officer
- Quality improvement coordinator
- Risk management specialist
- Director of quality management
- Clinical quality manager
- Healthcare quality analyst
Should I get a healthcare quality certification?
Pursuing a healthcare quality certification can be a significant boost to your nursing career if you are interested in specializing in quality improvement and patient safety. It provides you with specialized knowledge and skills in quality assurance, not only advancing your professional development, but also signaling your commitment to excellence to employers and potentially opening doors to leadership positions within the quality department of healthcare organizations. Certifications such as the Certified Professional in Healthcare Quality (CPHQ) offered by the National Association for Healthcare Quality (NAHQ) are recognized nationally and even internationally.
Before deciding, consider your career goals, the needs of your current role, the expectations of the healthcare market in your area, and whether you have the time and resources to dedicate to the certification process.
