Just as a ruler can’t determine air temperature, different measures prove useful for different jobs. Some measures focus on specific steps in providing care, such as whether heart attack patients receive prescriptions for beta blockers and antilipid medications at discharge. Other measures use a wide-angle lens to look at results — for example, whether patients sent home from the hospital have improved health or end up coming back with complications that could have been avoided. Each tool provides a different view — assessing performance from a specific angle. The more we see, the more information we have to choose wisely and make improvements.
NQF endorses a portfolio of tools designed to create a way of seeing and knowing whether care is achieving defined benchmarks.
Process Measures show whether steps proven to benefit patients are followed correctly. They measure whether an action was completed — such as writing a prescription, administering a drug, or having a conversation. Examples:
Examples of process measures
Universal Documentation and Verification of Current Medications in the Medical Record
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Percentage of patients whose medical record contains a list of current medications with dosages verified with the patient or authorized representative.
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Initial antibiotic received within 6 hours of hospital arrival
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Percentage of patients with pneumonia who receive their first dose of antibiotics promptly after arrival at the hospital.
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Cervical Cancer Screening
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The percentage of women who had a cervical cancer screening with a Pap test.
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Childhood Immunization Status
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Percentage of children 2 years of age who had four DtaP/DT, three IPV, one MMR, three H influenza type B, three hepatitis B, one chicken pox vaccine (VZV), and four pneumococcal conjugate vaccines by their second birthday.
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Outcomes Measures take stock not of the processes, but of the actual results of care. They are generally the most relevant measures for patients and the measures that providers most want to change. Examples:
Examples of outcomes measures
Falls with injury
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Rate of patient falls with injury in a hospital.
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Surgical Site Infections
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Percentage of surgical site infections occurring within 30 days after the operative procedure.
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Controlling High Blood Pressure
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Percentage of hypertension patients whose blood pressure is under control.
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Acute Myocardial Infarction 30-day Mortality
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Rate of deaths from any cause within 30 days after hospitalization for a heart attack.
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Body Mass Index (BMI) in adults > 18 years of age
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Percentage of adults who had an evaluation of their weight.
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Patient Experience Measures record patients' perspectives on their care. Examples:
Examples of patient experience measures
CAHPS Clinician/Group Surveys — (Adult Primary Care, Pediatric Care, and Specialist Care Surveys)
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Surveys of patient experience with primary care for adults and children and with specialist care.
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HCAHPS
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Patient experience with care survey for patients who have been in the hospital.
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Family Evaluation of Hospice Care
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Family Evaluation of Hospice Care.
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Structural Measures reflect the conditions in which providers care for patients. These measures can provide valuable information about staffing and the volume of procedures performed by a provider. Examples:
Examples of structural measures
Nursing Care Hours per Patient Day
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Number of productive hours worked by nursing staff with direct patient care responsibilities per patient day.
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Adoption of Medication e-Prescribing
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Documents whether provider has adopted a qualified e-prescribing system and the extent of use in the ambulatory setting.
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Medical Home System Survey
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Percentage of practices functioning as a patient-centered medical home by providing ongoing, coordinated patient care.
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Composite Measures combine the result of multiple performance measures to provide a more comprehensive picture of quality care. Examples:
Examples of composite measures
Mortality for Selected Conditions
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Measure of in-hospital mortality indicators for selected conditions.
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Pediatric Patient Safety for Selected Indicators
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Measure of potentially preventable adverse events for selected pediatric indicators.
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Learn how patient-centered measures = patient-centered results.
