Scott Hodson

Measuring Hospital Quality: Composite Measures

Measuring hospital quality effectively is a challenging task.  This article provides an approach that considers three critical dimensions of quality measurement, and provides an approach to developing a composite score.

Measuring Hospital Quality: Composite Quality Measures

To truly "move the needle" on quality, a hospital or health system must begin by clearly defining and it. While there is no standard healthcare industry definition of what constitutes "quality" in acute care services, we have found that top healthcare performers adopt a composite of measures that consider three dimensions:

• Clinical Outcomes: Ultimately it is the outcome that matters most. The patient’s goal in accessing healthcare services is to Risk adjusted healthcare quality measures such as inpatient mortality rate, readmission rate, complication rate are commonly accepted indicators of quality outcome success.
• Clinical Process: Effective clinical processes are essential to achieving superior healthcare quality outcomes. At a minimum, current publicly reported "core measures" that have been adopted for Acute Myocardial Infarction, Heart Failure, and Pneumonia, as well as the Surgical Care Improvement Project (SCIP) measures should be considered.

Evidence based physician order sets and clinical care plans provide a rich assortment of additional quality process measures.

• Resource Utilization:  "Too little" or "too much" care can adversely affect outcomes. Measures such as risk adjusted average length of stay, Intensive Care Unit average length of stay, and cost per case are examples of effective resource utilization indicators.

Top performing organizations not only define and measure healthcare quality, they ask the question: "How are we doing?"

We believe that the best way to answer that question is to compare your organization's results to those of "Top Performers." There are a number of organizations that provide excellent health care industry clinical quality and financial benchmark information. Through benchmarking, organizations are able to identify their strengths and weaknesses, and develop strategies to address and overcome healthcare quality gaps.

Benchmarked performance ratings can then be considered individually, and rolled up to measure overall quality performance for individual categories (e.g. Outcomes vs. Resource Utilization,) conditions (e.g. pneumonia vs. AMI,) individual hospitals within a health delivery system, or a system - wide composite score.

Many Top Performers establish quality performance goals, and compensate their leaders on degree of goal achievement.  As a culture of quality and patient safety evolves, patient and physician satisfaction increases, market share and revenues rise, and financial performance improves dramatically.

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