Evaluating the Quality of Health Care

4. Types of Quality of Care Measures

Process measures assess whether a patient received what is known to be good care. They can refer to anything that is done as part of the encounter between a physician or another health care professional and a patient, including interpersonal processes, such as providing information and emotional support, as well as involving patients in decisions in a way that is consistent with their preferences, etc.

Outcomes refer to a patient's health status or change in health status (e.g., an improvement in symptoms or mobility) resulting from the medical care received. This includes intended outcomes, such as the relief of pain and unintended outcomes, such as complications. Although the term “outcomes” is sometimes used loosely to refer to results such as mammography rates, such measures are actually process measures in the Donabedian sense. There is also a category of measurement called intermediate outcomes. This includes measures like Hemoglobin A1c levels for people with diabetes and blood pressure measurements. These intermediate outcomes are often closely related to other health outcomes.

If quality-of-care criteria based on structural, process, or intermediate outcomes are to be credible, it must be demonstrated that variations in the attribute they measure lead to differences in health status outcomes.

For outcomes to be used as quality of care measures, they must reflect, or be responsive to, variations in the care being assessed (Deyo, Diehr, & Patrick, 1991; Terwee, Dekker, Wiersinga, Prummel, & Bossuyt, 2003). For example, we know that taking blood pressures is necessary for monitoring how well blood pressure is controlled and that controlling blood pressure reduces the probability of heart attacks, strokes and other bad outcomes. We also know that certain outcomes, such as death after being treated in a hospital for a heart attack is related to the quality of care provided.

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