Session 15: Healthcare Quality

What are the 6 domains of quality care?

- safe

- effective

- patient-centered

- timely

- efficient

- equitable

safe

avoid injuries to patients from care that is intended to help them

effective

avoid underuse and overuse

patient-centered

provide care that is respectful of and responsive to individual patient preferences, needs, and values, and ensure that patient values guide all clinical decisions

timely

reduce waits and sometimes harmful delays for those who receive and give care

efficient

avoid waste of equipment, supplies, ideas and energy

equitable

care quality does not vary due to personal characteristics (gender, ethnicity, geographic location, socioeconomic status)

What are the 2 fundamental questions we need to ask about clinical care quality?

1. Effectiveness (are the right things done): avoid overuse, underuse, and misuse

2. Efficiency (are things done right): avoid waste

What is Triple Aim (2008)?

1. population health

2. per capita cost

3. experience of care (individual care)

What is the Quintuple Aim (2022)?

1. population health

2. per capita cost

3. experience of care (individual care)

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4. health equity

5. workforce well-being and safety

What are the three types of healthcare quality measures?

- structure

- process

- outcome

structure

organizations' capacity, systems, and processes to provide high-quality care

- whether the organization uses electronic medical records

- ratio of providers to patients

- number or proportion of board-certified physicians

process

what the organization does to maintain or improve patient health

- percentage of people receiving flu vaccines

- percentage of people with diabetes who had their blood sugar tested and controlled

outcome

the impact of a healthcare service or intervention on a patient health status

- percentage of patients who die as a result of surgery

- rate of hospital-acquired infections

Population health measures

a broadly applicable indicator that reflects the quality of a group's overall health and well-being.

PRO- can be adjusted for age, sex, race

CON- doesn't capture quality of life

Examples:

- death

- births

- incidence of chronic disease

- life expectancy at birth

- infant mortality

Healthy People 2030

the united states' 10 year plan to guide national health promotion and disease prevention efforts

Subjective health measures

can be used to assess individual health measures

PRO- can be used at individual & and population levels

CON- depends on the respondent's interpretation of survey questions/ self-assessments

Examples:

- number of healthy days

- number of disability days

- morbidity (incidence of disease)

- activities of daily living limitations

The doctor checks joe's height and weight to calculate BMI.

process measure

Doctors prescribes blood pressure medication and sends prescription to joes pharmacy electronically.

structural measure

The doctor checks joes blood sugar levels.

process measure

Nurse takes joes blood pressure (second visit)

outcome measure

Nurse gives Joe a flu shot (second visit)

process measure

Joe completes survey about his experience during his office visit

outcome measure