Measuring Performance

HIQM 1200
 Measurement: The Starting Point

Measurement
• Measurement is a tool used to monitor the How are we
doing?
quality of some aspect of healthcare services.
• Absolute number Yes
• Percentage
Assessment
• Average Are we meeting
expectations?
• Ratio
No

Improvement
How can we improve
performance?
 Purpose of Measurement

UNDERSTAND CURRENT IDENTIFY WHERE EVALUATE HOW CHANGES IN

PERFORMANCE, IMPROVEMENT IS NEEDED, WORK PROCESSES AFFECT
AND PERFORMANCE.
 Effective Measurement

Accurate Useful

Easy to interpret Consistently reported

 Measurement
Categories
• Structure
• Process
• Outcome
• Patient experience
Structure Measures
• Assess the adequacy of the
environment in which medical care
takes place
• Example: Number of registered nurse
hours worked per nursing home
resident day
• Often used for licensing and
accreditation
 Process Measures
• Assess what is being done and
whether the system is working as
it should.
• Example: Percentage of women (age
42–69) who had a mammogram
during the previous
12 months
• The most common type of
healthcare performance measure
Outcome Measures
• Assess discrete, patient-focused
endpoints.
• Example: Percentage of hospital
patients who develop a urinary tract
infection
• Results can be influenced by
factors out of the provider’s
control.
 Patient Experience
• Patient’s perception of processes
and outcomes
• Percentage of patients reporting that
their doctor explained medication
side effects
• Percentage of patients reporting
their pain was well controlled
 Measurement Levels: System & Activity

Organization-wide
Setting System-Level Measure Activity-Level Measures
Performance Goal
Hospital Reduce incidence of Percentage of patients  Rate of staff compliance with
hospital-acquired who develop an infection hand-hygiene procedures
infections while in the hospital  Percentage of central vein line
catheter insertions done
according to protocol
 Percentage of staff immunized
for influenza
 • External influences
• Regulatory,
• Clinical
• Accreditation,
Selecting • Provincial/Federal Government
• MOH
Measurement • HQO
Topics • OHT
• CIHI
• Internal influences
• Strategic priorities of the organization
 How to Construct a Measure

IDENTIFY TOPIC OF DEVELOP MEASURE DESIGN DATA

INTEREST COLLECTION SYSTEM
 • What might the HIM director want to know about
the transcription of records?
• Consider the six Institute of Medicine key
dimensions of quality:
• Safe
Identify • Effective
Topic of • Patient centered
• Timely
Interest • Efficient
• Equitable
 Develop
Measure
Numerator:
• Define the measure in
fundamental measurement
terms.
• Culture results can be
inaccurate when
Denominator: specimens are
contaminated during a
blood draw. What data are
needed to measure the
percentage of blood
specimens collected for
culture that are found to
be contaminated?
 • Identify the best sources of accurate data.
Design a • Administrative files
Data • Patient records

Collection • Miscellaneous business and clinical information

Strategy
 What

• Study population
Design a • Sample or not?
Data Who
Collection
• Data collectors
Strategy • Provide oversight of data collectors
• Provide sufficient training and
supervision
 When

Design a • Frequency of data collection

• Frequency of data reporting
Data
Collection How
Strategy
• Data collection instruments
• Electronic data query
 Created using a rigorous process

Externally Detailed data specifications are

Developed available and should be used by
data collectors
Measures
Be sure your internal definitions
match the data specifications
for the measures
 • List of core indicators by the Association of
Public Health Epidemiologistsof Ontario
Example: • Fall-Related Emergency Department Visit

Externally • the total number of emergency

department (ED) visits (not scheduled)

Developed for unintentional fall-related injury

relative to the total population during a
given year (fiscal or calendar) (usually
Measures expressed per 100,000)
 • Clinical decision making: Process by which
physicians and other clinicians determine which
patients need what and when
• Measures of clinical decision making
Clinical • Often derived from clinical practice guidelines:
“Systematically developed statements to assist
Measures practitioner and patient decisions about appropriate
health care for specific clinical circumstances”

Source: Institute of Medicine. 1990. Clinical Practice Guidelines:

Directions for a New Program, edited by M. J. Field and K. N. Lohr.
Washington, DC: National Academies Press.
Clinical Measures Topic of Evidence-Based Process
Interest Measure
• Measures of clinical Percentage of children aged 2 through
decision making 18 with a diagnosis of pharyngitis who
Management of
• Primarily evidence- children with were prescribed an antibiotic and
based process pharyngitis received a group A streptococcus test
measures for the episode

Percentage of patients aged 18 through

Management of 75 with diabetes mellitus whose most
patients with recent blood pressure measured less
diabetes mellitus than 140/80 mm Hg
 What Is a Balanced
Scorecard?
• A balanced scorecard is a
framework that helps
organizations put strategy at the
center of the organization by
translating strategy into
operational objectives that drive
behavior and performance.
 Balanced
Scorecard
Categories
Vary among healthcare
organizations
Example: Sunnybrook
Hospital Scoreboard
 • Measurement alone does not improve
performance.
• Results must be analyzed to determine whether
performance is acceptable and to identify areas needing
improvement.
M easurem ent
How are we
Measurement: doing?

Just the Starting Yes

Point Assessm ent

Are we meeting
expectations?

No

Im provem ent
How can we improve
performance?
Developing • For any healthcare activity, three
performance factors can be measured:
Measures structure, process, and outcome.
• Identify one structure measure, one process
for measure, and one outcome measure that
Hospital could be used to evaluate the following
hospital admission process:
Admission
 • Upon arrival, the patient reports to the hospital
registration or admitting area.
• The patient completes paperwork and provides an
insurance identification card, if insured.
Developing • Often, patients register before the date of hospital
admission to facilitate the registration process.
Measures • An identification bracelet including the patient’s
for name and doctor’s name is placed around the
patient’s wrist.
Hospital • Before any procedure is performed or any form of
medical care is provided, the patient is asked to sign
Admission a consent form.
• If the patient is not feeling well, a family member
or caregiver can help the patient complete the
admission process.