Institute: ONC | Component: 2 | Unit: 7 | Lecture: a | Slide: 7
Institute:Office of National Coordinator (ONC) Workforce Training Curriculum
Component:The Culture of Health Care
Unit:Quality Measurement and Improvement
Lecture:Definitions and framework for assessing quality What is known about health care quality
Slide content:Process vs. Outcomes In general, want to focus on outcomes Represents what actually happens to patient But difficult to measure; confounding factors Do we know about relationship between process and outcomes? In acute coronary syndromes, strong correlation between process and outcome measures (Peterson et al., 2006) In other areas, however, not a strong relationship between satisfaction with care ( global ratings ) and its technical quality (Chang et al., 2006) The science behind care also changes (e.g., recognition that too tight of control [HgbA1C] in diabetes can be detrimental) (Aron & Pogach , 2009) Consensus not always reached (e.g., drugs to avoid in elderly) (Steinman et al., 2009) 7
Slide notes:In looking at process versus outcomes, many quality measures are actually measuring process, or how care was provided. But the goal is to measure outcomes: how patients respond to care, how their health improves, or how their safety is increased. Outcomes represent what actually happens to the patient. However, outcomes can be difficult to measure and also have confounding factors. The patient may receive the highest-quality process care, but for some reason unrelated to that care, the patient has a bad outcome. Is there a relationship between process and outcome? In some areas, such as acute coronary syndrome, theres a strong correlation between the two: the process measures that are undertaken and the outcomes that result. But in other areas, the relationship is not as strong. In particular, it has become clear that patient satisfaction with care often does not have a correlation with the technical quality of that care. A 2006 study measured patient care based on a quality assessment system for vulnerable older patients against the perceptions those patients had of their care. The study determined that patients rated their care higher than the technical quality actually measured. The science behind the care also changes. For example, the clinical thinking about diabetes control has changed over the years. Some of these changes get incorporated into quality measures, but it may turn out that the science of care has changed, so the quality measures need to change. Sometimes theres no consensus on the best care. For example, theres a lot of interest, especially with regard to safety, about drugs that physicians should avoid prescribing to the elderly. But it turns out that its difficult to achieve consensus on what those drugs are. 7