Measuring Quality

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Measuring Quality
Quality monitoring is becoming an accepted method for purchasers, patients, and providers to evaluate the value of health care expenditures. Important advances in the science of quality measurement have occurred over the past decade, but many challenges remain to be addressed so that quality monitoring may realize its potential as counter force to the demands of cost containment.
The structure of the U.S. Health care system is changing rapidly, primarily in response to concerns about the increased costs of health services. Many of these changes create disruptions in the way health care professionals are allowed to provide care and the way in which patients may seek care. Although these disruptions may inconvenience clinicians and patients in the short run, ultimately we want to know the longer-term effect of these new strategies on the health of the population.
Quality assessment offers one method for evaluating the impact of changes in the organization and financing of health services on health. If there were a precise relationship between price and quality, we would only need to know how to translate premium prices and other charges into quality units. However, because there is no such direct relationship, a separate set of quality measures is essential (Soumerai, Avorn, Ross-Degnan, & Gortmaker, 1987). Expanding the information available on quality requires the development of valid measurement tools and routine access to the right data.
The Institute of Medicine (IOM) has defined quality as “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge” (Lohr, 1990). The definition suggests that (1) quality performance occurs on a continuum, theoretically ranging from unacceptable to excellent; (2) the focus is on services…...

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