A tale of two healthcare measures
By Thomas Day
Healthcare quality has always been important and in the “dark ages” – left largely to reputations and word-of-mouth referrals. Increasingly, there are more ways to measure quality – not to the exclusion of reputations and referrals from trusted sources – but these measures provide more information to make better-informed decisions. Two key publicly-available measures are AHRQ (Agency for Healthcare Research and Quality) indicators, and Process-of-Care measures
Let’s first examine AHRQ indicators. These measure how often things that “should not happen” occur during hospitalization. So, a hospital acquired infection is something that is bad – should not happen – but does occur on occasion. It is crucial to know how often these things happen in one’s own facility and compare their frequencies to how often they occur in other hospitals. This applies both when evaluating or managing a hospital. There are many AHRQ indicators, and they cover most hospitalizations. Some examples of the things measured are the “Mortality in Low Mortality DRG,” or the “Foreign Body Left in During Procedure.”
Then there are Process-of-Care measures, that largely measure things that have been deemed events that “should happen.” When these things occur, the outcome of the treatment will be better. These measures cover categories such as asthma care, heart attack, heart failure, and pneumonia treatments. In these categories, the probability of a good outcome is enhanced by doing these things. Put another way, they mean: “If you do these things, the result should be better.” They also examine readmission rates within 30 days (such a readmission is presumed to be bad) and mortality within 30 days, as evidence of better or worse care. However, these Process-of-Care indicators consider only a few categories of treatment, and so they provide a limited window into the full quality of care delivered.
All that said, there’s more to care than these indicators measure. I had my knee replaced by an extraordinarily skilled surgeon. The device was a perfect fit, and the “carpentry work” to install also extraordinary. The recovery program was very effective, the quad muscle wasn’t cut (enabling more ultimate strength), and my restored functionality remarkable. None of these things is measured by either set of indicators.
So quality is getting more measurable, but each indicator tells a different story and there’s a lot to be done yet. I’d want good indicators all around, but I sure wouldn’t want to ignore the physician’s skill too.
Thomas Day is president of HMC.
