Linking process, structural and outcomes data to obtain actionable information

September 1, 2006

As the healthcare industry strives to establish appropriate and effective standards for the public reporting of clinical data, providers may lose sight of how they can make a critical difference in ensuring new reporting standards do not distract from, but rather aid in, achieving the primary goal of improving patient care.

As the healthcare industry strives to establish appropriate and effective standards for the public reporting of clinical data, providers may lose sight of how they can make a critical difference in ensuring new reporting standards do not distract from, but rather aid in, achieving the primary goal of improving patient care.

The relationship between measurement and performance improvement is in debate by several independent and government organizations. One of these organizations is the National Quality Forum (NQF), the independent organization of healthcare leaders from both the payer and provider communities tasked with endorsing consensus-based standards for measurement and public reporting. The hope is the group will endorse only evidence-based standards that will be used to measure care providers.

As an active member of the NQF, I know that the committees are taking a smart and sophisticated approach to reviewing these standards. However, as an advocate for hospitals and health systems and as a healthcare consumer, I often wonder if the debate is as robust as it could or needs to be. In large, I believe the discussion falls short for a key reason: Providers are less knowledgeable about the details of the standards and often under-participate in the discussion of which measurements truly reflect quality care and which of those measurements are essential to improving a hospital's patient outcomes.

Consider a parallel to the game of golf. It's clear that filling out a scorecard, hole to hole, may motivate golfers to concentrate harder on the next hole, or make them more determined to improve in general. However, keeping score in and of itself does not make a person a better golfer. Likewise, reviewing stroke, stance or equipment, without knowing if the player completed the hole at or above par, does not allow the golfer to know if and how he or she is improving their game. If it did, we would all be Tiger Woods.

Instead, effective golfers know that it is only by reviewing the interplay between process data (technique, strength of the swing, stance, equipment, etc.) and outcomes data (the resulting score) that a person can use that information to improve his or her game.

Senior healthcare leaders at provider organizations must recognize that it is not the NQF, or any other organization, alone that will have to live with the results of the measures. These measures have the potential to impact funding, compensation and patient choice-not to mention competition between local hospitals and health systems. They also can affect healthcare providers' ability to contribute to new or existing quality initiatives that can have a genuine impact on care improvement.

For all of these reasons, I am anxious to encourage each and every provider who I encounter, or who may read this article, to participate in the broader discussion, actively advocating both process and complimentary outcome measurements that translate to quality improvement. By participating in these debates and helping to shape policy, you will also be in a position to ensure that your hospital and your peers are gathering actionable data that will improve the level of care and the health of your respective patients.

The following list has a few suggestions and steps that members of the healthcare provider community can initiate today to ensure this process moves forward: