Rate based measurements

Answer

Rate-Based Measures

Rate-based quality measures refer to the evaluation standards for the performance of healthcare providers in regard to the care delivered to populations and patients   The three major types of rate-based quality measures include structure measures, outcome measures, and process measures (Contreras, 2018). The three measures are used to identify and measure critical elements of care such as effectiveness, fairness, timeliness, and safety (Contreras, 2018). The three measures were chosen for this paper because they capture diverse aspects of the delivery of healthcare and together, they provide a more inclusive and comprehensive picture regarding the quality of healthcare delivered by health facilities (Quentin et al., 2019). The paper describes three rate-based quality measures, highlights how the measures are numerically constructed, and evaluates how data for the measures are collected.

Chosen Care Organization

            Grady memorial hospital is an example of a public care facility located in the US. The hospital has inpatient and outpatient services. Grady Memorial Hospital is the fifth-largest healthcare facility in the US and is located in Atlanta. The facility is known to be one of the busiest ones in the region (Brus, 2015). Process, Outcome, and Structure rate-based measures will be explored within the context of this care facility.

Chosen Rate-Based Measures of Quality

Structural measures are the measures used to determine the capacity or ability of a healthcare facility to deliver quality health care services   Structural rate-based measures are backed up by the evidence that there exists an association or link between the rate-based measure and other domains of medical quality measures (Contreras, 2018). Structural measures can be used to measure domains such as the ratio of caregivers to patients, the proportion or number of board-certified physicians, and the use of medication order entry or electronic medical records systems. Structural rate-based measures give patients a sense of high-quality care because the processes, capacity, and systems of the facility are well articulated (Contreras, 2018). 

Outcome rate-based measures refer to those measures that highlight the effects of healthcare interventions or services on the health status and outcome of the patients (Contreras, 2018). Outcome rate-based measures are validated by the evidence that the measure has been utilized in the detection of the effect of one or numerous clinical interventions (Contreras, 2018). Outcome measures can be used to determine incidences such as death due to cancer, pre-clinical mortality, post-MI one-month mortality, and the rate of hospital-acquired diseases. Outcome measures are crucial because they measure the effectiveness of various programs implemented by a health facility (Jazieh, 2020).  

Process measures reflect the actions undertaken by healthcare facilities to improve or maintain health for patients diagnosed with a specific health condition or for healthy people (Contreras, 2018). Process measures usually reflect the measures that are generally recommended for medical practice. Process rate-based measures are supported by the evidence that measure focus or clinical process has contributed to enhanced outcomes (Contreras, 2018). For instance, process measures can be used to measure the percentage of individuals who were administered thrombotic therapy within forty-five minutes after symptoms start to manifest.

Reasons Why the Measures are identified

            Processing and analyzing raw data is difficult and time-consuming. For this reason, measures are numerically constructed to facilitate easier organization and interpretation of the collected information (Quentin et al., 2019).

The numerical description of how the measure is constructed 

Structural, outcome, and process measures utilize similar numerical constructs to analyze data. Data can be created numerically using counts, ratios, rates, percentages, and sums. Counts reflect the number of observations or items such as the number of individuals participating in a survey. Rates describe a quantity in relation to a given element or unit (Rios-Zertuche et al., 2019). Ratios are the fractions that examine two entities in relation to each other. Sums are the additions of observations or items.

            Rates and ratios can be utilized to adjust for the effects of natural changes in a healthcare system such as volume (Jazieh, 2020). The denominator detonates the volume or unit of production, for instance, total patients waiting and the total cost while the numerator represents the key measure, for example, patients waiting and costs (Jazieh, 2020). For instance, if the number of patients waiting for three hours increases drastically, one can draw a single conclusion, which may not be accurate. However, if one knows that the general volume has also increased, which in this case would be indicated in the rates or ratios, then an individual would most likely draw another conclusion, which is more accurate. In some instances, the denominator may so large that the change may be so subtle to perceive (Jazieh, 2020). In such cases, it is recommended to use whole numbers to provide a detailed perspective (Rios-Zertuche et al., 2019). There is no specific formula for constructing the three measures since each data collected and the purpose of the evaluation is diverse (Jazieh, 2020). Organizations reviewing the data adjust their formula based on the type of assessment required (Quentin et al., 2019).

How the data for the measures are collected

            The three measures utilize similar methods to collect data. Data can be collected through surveys, where self-reported data about individual clinical experiences are captured through survey instruments from patients. Such surveys capture elements such as a report on service, care, and treatment (Braspenning et al., 2020).  Information can also be collected by examining and analyzing administrative and patient medical records (Quentin et al., 2019). Administrative and patient medical records data can provide essential elements such as codes of diagnosis procedure for healthcare services, service location, billed amount, and type of service, which are collected from enrollment, claims, providers systems, and encounters (Rios-Zertuche et al., 2019).

How the measurement is compared externally to other like settings, and difference between the actual rate and a percentile ranking

            The rate-based measurements are compared externally to other similar settings by generating indicators which can be used to establish if there is any improvement within the care processes provided by the patient. The indicators make it easier to engage in a benchmarking process over time within similar external settings (Rios-Zertuche et al., 2019). According to Contreras (2018), utilizing indicators makes it simpler to compare the measures in similar external settings in that the professionals and organizations are enable to take part in the process of monitoring and evaluation of the patient’s needs. Additionally, the indicators will be effective in providing a standard of care that can predict the outcomes of the rate-based measures as implemented in different settings.

            Actual rate and percentile ranking varies. Notably, the actual rate refers to the mathematical value which is presented out of 100 while percentile refers to the per cent of values prevailing below the specific value (Rios-Zertuche et al., 2019). Additionally, the actual rate is also utilized as a means of comparing quantities while the percentile value is implemented to provide a display of a rank or position (Quentin et al., 2019).

Measures and Risk Adjustment

            Process measures are not risk adjusted. However, it is evident that the process’ measure target population is normally defined in a manner that it includes all the patients for whom the process measure is deemed as appropriate. The defined need for the risk-adjustment is to ensure that an accurate comparison of the performance of the care facility or the clinician is enabled (Centers of Medicare and Medicaid, 2017). Outcome measures such as mortality are known to be risk-adjusted. Notably, the outcome measures adjust for the patient characteristics which exist before an episode of care is accomplished which further makes the outcome more likely. For instance, the characteristics can include the patient’s past medical history, age, and comorbidities which enhances the chances of the outcome development (Centers of Medicare and Medicaid, 2017). The common formula for the risk adjustment for this measure is outlined below.

Risk-adjusted rate = (observed rate / expected rate) * reference population rate (Centers of Medicare and Medicaid, 2017).

The structural measures are also risk adjusted to ensure that the consumers can obtain a sense of the care provider’s ability to administer an effective form of care. This is achieved by providing a definition of factors such as if the care organization relies on the usage of medical order entry system or electronic medical records (Centers of Medicare and Medicaid, 2017).

Setting Goals for Each Measure

            Goals for the process measures can be set by considering the firm’s historical performance and the industrial norm which is associated with the goal. Data which will support the goal setting plan is utilized. This will make it simpler for the firm to set meaningful goals that ensures that its performance remains even more desirable over time (Ungermann, 2020). A process goal should have the capacity to encourage quality outcomes. For instance, an improved patient outcome is encouraged by process goal measures within the workplace. Outcome goals can be set through the use of a condition with a clear pass/failure (Ungermann, 2020). For instance, when a doctor is effectively able to diagnose a condition after reading the test results, then an ultimate outcome of “pass” will be recorded in this case. Performance goals can be set by defining the standards which the organization should achieve within a specified period of time. For instance, indicating that the nursing staff members should be in a position to handle the needs of at least 15 critically-ill patients during their shift are an example of a performance measure goal within firm (Ungermann, 2020).

Importance of the Rate-Based Measure

            Process measures are important to the clinical organization since they aid in uncovering problems in the firm, thus creating opportunities whereby improvement can be considered. By measuring the process performance of the firm, it becomes simpler for the business to change behavior with a focus on ensuring that the firms rely only on positive behavior to record a positive behavior after risk performance (Alhowimel et al., 2021).

            Outcome measures are important to the organization since they provide an insight into the firm’s fundamental financial performance which is requisite towards supporting its operations. The outcome measures will provide an indication into the cost and quality targets which the business should focus on improving to ensure an effective and sustainable outcome. The outcome measures that can be considered for improvement within the organization includes mortality rates, instances of patient readmissions, and outcome measures among others (Isba et al., 2020). The structural measures are also important to the organization because it provides the patients with an insight into the capacity of the healthcare provider, the processes, and systems which are necessary in the provision of a high-quality form of care (Rios-Zertuche et al., 2019).

Relationship to Patient Safety and cost of poor quality

            Process measures is related to patient safety in that it assesses how a firm adheres to the prevailing safety standards (Contreras, 2018). For instance, this can include an assessment on matters such as the proportion of the surgical patients for whom a checklist on postoperative care is completed within the facility. Outcome measures is related to the safety of the patient in that it documents a measure of the prevalence of the adverse events within the facility (Rios-Zertuche et al., 2019). For example, the outcome measure can present an outcome of the level of harm which the patients experience mainly due to their interaction with the health cares system related with near misses or other adverse events. Structure measure is related with patient safety since it assesses the ability of the care facility in providing quality and effective care to the patients (Contreras, 2018). For instance, the structural measure will demonstrate if the care facility has enough technology capacity to offer adequate care by preventing instances of error and serious adverse events from occurring.

            Process measure will provide an insight into the monitoring activities which are related to quality such as labor productivity and the quality of care administered to the patients seeking care in the facility. Outcome measures will provide an insight into how the facility can prevent the cost of poor-quality delivery in the facility such as ensuring that only qualified and competent care professionals are hired in the firm. Structure measures seek to ensure that quality is improved by devising an effective cost structure to support the firm’s activity for a positive patient outcome. This results to a reduction in the overall cost of healthcare by avoiding expenses of errors.

Conclusion

In conclusion, rate-based quality measures can be defined as the measuring standards for the performance of the providers of health care in relation to the care delivered to populations and patients. The three major types of rate-based quality measures include structure measures, outcome measures, and process measures. Structural, outcome, and process measures utilize similar numerical constructs to analyze data. Data can be created numerically using counts, ratios, rates, percentages, and sums. The data used can be collected through surveys or by examining and analyzing administrative and patient medical records.