Healthcare Metrics

The use of metrics in the healthcare industry is particularly interesting given that the industry affects everyone, focuses on saving lives, the diversity of services/supplies involved, as well as the maturity of supporting standards, tools, and comparison data.

Motivation

The healthcare industry continues to focus on improving the quality of patient care, reducing administrative/clinical costs, and becoming more "patient-centric". The collection and analysis of various process/quality metrics play a significant role in these efforts by enabling hospitals, clinics, and other healthcare providers to identify areas of improvement and quantify/monitor performance. They also empower consumers and insurance payers to make informed decisions regarding choices among healthcare providers.

Metric Types

At a high-level, healthcare metrics can be classified into the following basic types (see examples):

Standards/Sources

Commercial, Non-Profit Accreditation Organizations

The non-profit accreditation organizations that establish the performance standards/criteria by which healthcare systems/facilities are regularly evaluated by assessors also provide a growing source of metric data. Accreditation reflects a “symbol of quality” and is often used a condition of reimbursement from insurance payers or the government (e.g., Medicare).

There are a wide variety of accreditation organizations; each addresses one or more healthcare system types. As examples,

The standards/criteria used by accreditation organizations tend to have a "process/procedural checklist" orientation (e.g., Is there a documented process for prescribing and dispensing drugs?, Is there an educational program for training staff on facility procedures?), although some criteria is based on quantifiable measures/statistics. The information available to consumers from their web sites typically reflects only current facility accreditation status (e.g., "Accreditation with Requirements for Improvement").

Formally, the definition of detailed, industry-standard healthcare metrics is being slowly led by JCAHO (see link above), which remains the U.S.'s predominant standards-setting and accrediting body for healthcare organizations. In 1997, JCAHO announced its "ORYX" initiative to begin to standardize on detailed quality/performance metrics in a step-wise fashion (over-time); its initial focus (in 2001) was the establishment of standard hospital metrics for acute myocardial infarction, heart failure, community-acquired pneumonia, and pregnancy and related conditions.

Government Entities

The Centers for Medicare & Medicaid Services (CMS) (formally, the Health Care Financing Administration or HCFA) administers the Medicare and Medicaid programs. CMS also certifies laboratories against its established (CLIA) laboratory quality standards; however, no metric data is available to consumers.

Medicare (itself) provides high-level utilization metrics and recent survey deficiency results for nursing homes and dialysis facilities to consumers via their web site. The site also includes quality measures (e.g., % of residents with loss of ability in basic daily tasks, % of residents with pressure sores, % of residents with infections) for each of the nation's 17,000 nursing homes which accept Medicaid and Medicare payments, along with respective state and national averages.

A few states have sponsored programs for the collection/dissemination of detailed metric data. For example, California's Office of Statewide Health Planning and Development provides a means whereby detailed financial, utilization, and some clinical performance data for all California hospitals may be accessed via the web.

Commercial Metric Providers

For healthcare providers, the primary source for detailed quality/performance metrics remains commercial healthcare metric data providers. These commercial providers collect performance data from various healthcare providers, and establish peer performance "benchmarks" against which healthcare providers may compare their own performance. They then sell the "benchmark" data to healthcare providers, often along with applications that enable providers to input data for their respective system/facility.

They also provide software tools that facilitate the identification of variances of procedures and supplies for physician-driven treatments (to promote their standardization), comparison against peer benchmark data to identify performance improvement opportunities, as well as the ability to measure/monitor performance over-time to quantify improvements. The most popular providers of benchmark data and supporting analysis tools are:

Metric Examples

Example metrics for the basic metric types are provided below. In general, historical versions of these metrics would be tracked to monitor performance improvement and performance against control points. To promote the comparison of data regarding specific conditions (e.g., congestive heart failure) and procedures (e.g., coronary by-pass surgery), industry coding standards are used. These include Medicare Diagnostic Codes (MCD), Diagnostic Related Groups (DRG) primarily used as the basis for billing, International Classification of Diseases (ICD-9), and the AMA's Current Procedural Terminology (CPT4).

Financial
Utilization
Cost/Productivity
Clinical Performance
Safety
Patient Satisfaction