Quality metrics are measures that the Centers for Medicare and Medicaid Services (CMS) and other regulatory agencies use to assess the clinical performance, care quality, and safety measures of all healthcare providers. These metrics can be classified in three ways:
- Structural measures
- Process measures
- Outcome measures
Structural measures refer to the basic infrastructure of a hospital or other healthcare facility. These measures are used to assess whether the care provider has a good doctor-to-patient ratio, a sufficient number of board-certified physicians, or whether the facility is using up-to-date systems like electronic health records (EHRs) for patient data management.
Process measures refer to the clinical practices that doctors, nurses, and other providers use when administering care. For instance, these measures could be used to determine what percentage of patients with diabetes had their blood sugar levels tested by their primary care provider (PCP) or endocrinologist. This helps to ensure that all care providers are adhering to best clinical practice guidelines, and that patients receive the expected medical care for their disease or condition.
Outcome measures refer to quantifiable patient outcomes as a result of medical treatment or intervention. These most commonly include measures like 30-day readmission rates, mortality rates, and hospital-acquired condition scores.