What are quality metrics in healthcare?

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.

Why are quality metrics important in healthcare?

Quality metrics provide important insight into areas of patient safety or clinical performance that might need improvement. By regularly measuring healthcare quality performance, regulatory agencies like CMS and the Agency for Healthcare Research and Quality (AHRQ) can help to increase care standards and reduce unnecessary risks associated with poor clinical quality.

Clinical and quality performance measures can also indicate issues with patient communication, cultural incompetency, and staffing shortages—areas that have a significant impact on clinical outcomes and patient experience.