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What does quality mean in healthcare? From measures to metrics

By Dr. Richard Parker, Chief Medical Officer at Arcadia
Quality Improvement Value-Based Care

The word “quality” gets thrown around a lot in discussions of healthcare. Politicians opine about delivering Americans “higher quality” health care at a lower cost. Insurance companies and healthcare networks advertise their high-quality care in advertisements to patients. Data analytics vendors will wax poetic about quality for hours (it’s much easier to read those thoughts in writing).

Quality means a lot of different things to a lot of different people and organizations within the US healthcare system. Here, we delve into the term’s usages, from official definitions (like MIPS quality measures) to its more general connotations in medicine.

Quality, like obscenity: “I know it when I see it”

The English Oxford Living Dictionary defines quality as “the standard of something as measured against other things of a similar kind; the degree of excellence of something” or alternatively, “a distinctive attribute or characteristic possessed by someone or something.” These definitions are too broad to be especially helpful in healthcare, but they point to the right direction — measuring a doctor or network or system’s performance in relation to the status quo.

Attempting to define quality evokes the famous quote of Supreme Court Justice Potter Stewart. In 1964, Justice Stewart said that he could not define “obscenity,” but “I know it when I see it”. As a doctor, a Chief Medical Officer and an occasional patient, Arcadia CMO Dr. Rich Parker knows quality when he sees it.

What do we mean by quality measures?

One way to figure out how to define quality is to look for areas of healthcare that you wish to measure (commonly called, well: quality measures). Some examples Dr. Parker provided include:

  1. The skill of the doctor and other providers to make correct and timely diagnoses
  2. Tests that are performed correctly
  3. Test results are shared with the patient in a timely and understandable way
  4. Staff answer the phones when patients call
  5. Access to care is reasonably timely for both routine needs as well as urgent or emergent needs
  6. Providers communicate with each other about complex patients to assure the best outcomes
  7. Doctors follow up with patients at the correct intervals
  8. Hospital and ambulatory facilities are clean
  9. Healthcare personnel adequately wash their hands
  10. Providers avoid over-testing and over-treating

This short list demonstrates that measuring quality in all of these domains is not easy, especially in a standardized way.

Much attention has been paid to the quality measures doctors must hit in value-based care contracts. These measures, such as rates of completing mammograms, Pap smears or colonoscopies, are useful, but as you can see from the list above, they cannot come close to measuring the totality of care (and by extension the total quality of care).

CMS and MIPS use of quality measures

There are a few instances where “quality” takes on a very concrete role. One example is quality measures, the guiding standards set forth by the Centers for Medicare & Medicaid. These measures are a litmus test for everything from public reports (which hospitals give patients the best treatment based on cost) to goal-setting initiatives.

Another example is MIPS quality standards. MIPS stands for merit-based incentive payment system, a performance-based program under which providers working with Medicare Part B receive compensation based on the level of care they deliver.

Quality as perceived by patients

The list above refers to concerns that a patient, physician, healthcare system, or payer might have about aspects of quality performance. But how is quality as perceived by the patient reflected back to the providers?

Currently, a movement is afoot to use more patient-reported perceptions of care as useful feedback to providers. Some insurers call these PROM – Patient Reported Outcome Measures. For example, patients may use IT to report back to their providers on how they are recovering from an elective surgery or how they might be progressing with treatment for depression. I believe there is tremendous opportunity in using feedback from patients that flows directly in to the electronic health record.

This should and will be an area of growth and innovation in the years ahead. Any industry, including healthcare, should receive and perceive all feedback as gold on the path of continuous quality improvement.

“Quality” is used in myriad ways in the healthcare setting.

  1. Individual patients have their own personal definitions of quality at the micro level — for example, measures of quality might be the patient’s satisfaction with the wait time in the exam room or how the doctor communicated
  2. Providers have their own definitions of quality — whether that refers to a specific quality measure, like “all of a provider’s patients under 2 years old received the appropriate vaccines” — or to the overall care provided to a patient and the patient’s outcomes
  3. Payers also measure quality of care at both the micro level of services provided to a specific patient, and in the aggregate macro level in terms of measures that track the quality of care provided to a population

The quality difference in healthcare data analytics

However you use quality in the context of medicine, it’s an essential trait of trustworthy care. The same holds true with data analytics — when you can trust the sources, algorithms, and outputs, you can make plans and grow your organization with confidence. Learn more about how Arcadia can deliver high-quality healthcare data to power transformation.