Welcome to the module on measures and measurement. I hope everyone is having a good day today and is ready to explore measures and their application to the measurement of health care quality. However, speaking of having a good day, if at the end of the day someone asks, how was your day? How might you measure the quality of your day? Would it be a good day if you had few challenges, or had time to exercise? Would you include your ability to understand the concepts in this course as a measure? Or perhaps the number of positive statements from other people about your work? While you may not be fully conscious of them, you likely used many types of informal measures to determine whether or not you are having a good day. And by the way, I hope you're having a wonderful day today. In reality we used many types of measures everyday. Some implicit like those to gauge if you're having a good day. And some explicit and more precise, such as using a tea spoon or a measuring cup in cooking. In some instances we may rely on a single measure, like a tea spoon and at other times we may use a large set of very complex measures, as when we are constructing a building. In this episode, we'll explore how we can apply basic measures and measurement concepts to our everyday work in the health care environment. Up until the last three decades, there was relatively little use to formal measures to try to determine safety and quality in health care. In general patients and providers assumed that health care quality was high fail to uniform largely based on the belief that the depth and breadth of education programs along with professionalism will sufficient to ensure quality. Well education and professionalism are certainly important in fostering excellence in health care. When we actually started to measure quality in safety in the 1980s using rather could measures. We discovered to art is may that, there was a wide variation in performance and in some cases rather low average performance. A large body of evidence since these early efforts has supported the initial findings and reinforced the victim that the only way to know the quality of care provided is to measure it. A measure in healthcare is simply a defined tool used to quantify healthcare processes, outcomes, patient perceptions, and the healthcare delivery system. While measurement or more precisely good measurement, is the process of applying the right measures to the right situation in the right way. To use an analogy, if you were building something and wanted to determine the length of a board you would need both a standardized measure like a yardstick. And you would need to apply it in a careful and precise manner like lining the yardstick up with the edge of the board and lining it straight to create a useful measure. It will be helpful at this point to understand a bit more about general categories of measures. Avedis Donabedian, a pediatrician and a major figure in early quality measurement, proposed what has become an enduring framework for measurement back in the 1960s. He identified three important construct to characterize quality, structure, process, and outcome. Donabedian's Framework is remained an important approach to defining measures and we will be exploring the framework in more detail later in this module. The Donabedian framework of structure process and outcome can be applied to the many different kind of things we might want to measure in health care. One widely used formulation of what we want to measure was developed by the institute of medicine. The IOM's Seminole publication, Crossing the Quality Chasm, defined six aims for quality health systems. The six aims call for healthcare that is safe, patients should be as safe in healthcare facilities as they are in their homes. Timely, patients should experience no waits or delays in receiving care and service. effective the science and evidence behind health care should be applied and served as the standard in the delivery of care. Efficient care and service should be cost effective and waste should be removed from the system. Equitable and equal treatment should be a fact of the past and disparities and care should be eradicated, and finally patient centered. The system of care should revolve around the patient, respect patient preferences and put the patient in control. An easy way to remember this aims is to use the acronym STEEEP. Each of these IOM goals can have measures of structure, process or outcome. In fact, the IOM's report included some ideas for defined sets of measures for each aim. Can you think of measures that might be useful in assessing how safe, timely, effective, efficient, equitable and patient centered a care system is. For instance, measures related to safety could include overall mortality rates with a percentage of patients receiving safe care. Timeliness can be measured in terms of waits and delays and receiving care services or test results. Effectiveness can be measured in terms of how well evidence based practices are followed. Such as the percentage of times diabetic patients receive all recommended care at each visit. Efficiency can be measure by analyzing the costs of care by patient, provider, organization, or community. For equitability, we can use comparative measures to determine whether or not the quality of service varies by socioeconomic status. And patient-centeredness can be measures in terms of patient and family satisfaction. Note, that some of the suggested measures sets included process as well as outcome measures. For example, the use of evidence based standards in the provision of care is a process measure. Mortality rate is an example of an outcome measure. It's important to note that while measures and measurement are critical to improving care, they're only a first step on a much longer path to actually improve safety and quality. While we'll focus in this module on measures and measurement we should not lose sight of the fact that we need measurements to guide and inform what should be our central focus. Making health care safer of higher quality through on going efforts and improvement. In the rest of this module, we will explore the structure, process, outcome framework in more detail, giving examples of each type of measure. You'll also learn about the attributes of a useful measure and how to select and implement measures successfully while avoiding potential pitfalls associated with measurement. So, see you in the next episode.
