Implementing Quality Measures in Healthcare- Process and Outcome Measures for Continuous Improvement
In the healthcare delivery industry, continuous quality Improvement (CQI) is a deliberate and defined process aimed at activities that focus on patients’ needs and improve population healthcare (McCalman et al., 2019). CQI aims to implement programs continuously to improve healthcare services. Outcomes measures indicate the effects of healthcare interventions on the health status of patients (Kampstra et al., 2018). An example of an outcome measure would be the rate of hospital-acquired infections. On the other hand, process outcomes indicate what healthcare conditions do to improve the health of their patients (Akmaz et al., 2019). An example of a process measure is the percentage of diabetic patients who have controlled blood sugar levels.
Process Measures Utilized for CQI
The two process measures that may be used in CQI are related to preventive healthcare services, and process measures signify the recommended healthcare practices in clinical settings (Akmaz et al., 2019). The first process outcome selected is the percentage of patients receiving preventive healthcare services such as vaccinations. Preventive healthcare services involve screening, wellness check-ups, and patient education, which prevent diseases and other adverse healthcare outcomes (Musich et al., 2016). The second process measure that can be used in a CQI is the percentage of diabetic patients whose blood sugars have been tested and controlled. Diabetes is a chronic condition with serious complications such as diabetic ketoacidosis, hyperglycemia, and even mortality if the blood sugar levels are not effectively controlled (Wang et al., 2018).
These two process measures can inform patients about the healthcare services they should receive for the medical conditions they are suffering from. This may help them contribute towards improving their healthcare outcomes. These two process measures can be used for quality reporting. These two measures have been defined by their relationship between the process and outcomes of healthcare services. They can provide data on the efficiency of healthcare services (Akmaz et al., 2019). Process measures are used to assess whether the healthcare organization uses the correct clinical guidelines when providing healthcare services. Process measures result in outcome measures (Akmaz et al., 2019). They are used to determine where the processes used were effective and indicate the next steps to be followed to improve the healthcare processes.
Outcome Measures Utilized for CQI
Outcome measures develop standards for healthcare outcomes and help quantify healthcare processes. They are mostly used for public reporting to insurance companies and the government (Kampstra et al., 2018). Some of the outcome measures include readmission rates, hospitalization rates, and surgical site infections. An outcome measure that can be used for a CQI is the rate of surgical site infections. Surgical site infections can result in healthcare complications, increase healthcare costs and result in loss of reimbursement for healthcare organizations (Abbas et al., 2020). This outcome measure will be used to monitor whether the healthcare process will result in the expected result. That is, whether surgery will result in low surgical site infections. Surgical site infections may be due to different factors, such as failure to use perioperative antibiotic prophylaxis (Abbas et al., 2020). Failure to achieve outcome measures will lead to a lack of outcome measures.
Reason for Selection of Each Measure
The percentage of people who receive vaccination was selected since the healthcare delivery industry is moving towards patient-centered healthcare services. Healthcare services are shifting from traditional pay-for-service volume-based payments to value-based healthcare reimbursements (Saleh & Shaffer, 2016). Healthcare organizations are being reimbursed based on providing quality healthcare services and reducing healthcare costs. Most of them are thus focusing on preventive healthcare services. The Affordable Care Act also advocates for preventive healthcare services (McIntyre & Song, 2019). The second process measure of the percentage of diabetic patients whose blood sugar is being tested and monitored was selected since diabetes is a chronic condition that may have serious complications if the blood sugar levels are not kept within the optimum levels (Wang et al., 2018). Poor glycemic control can also result in death. It is thus critical to measure this process outcome to identify patients at risk of poor glycemic control. This will help to implement interventions to manage their blood sugar levels effectively.
The outcome measure of surgical site infections was selected because it results in serious healthcare complications, increases hospital stay length, i