NURS 8302 Assignment 2: Tools for Measuring Quality ANSWER

• Describe the three rate-based measures of quality you selected, and explain why.
• Deconstruct each rate-based measure to include the following:
  • Describe the definition of the measure.
  • Explain the numerical description of how the measure is constructed (the numerator/denominator measure counts, the formula used to construct the rate, etc.).
  • Explain how the data for this measure are collected.
  • Describe how the measurement is compared externally to other like settings, and differentiate between the actual rate and a percentile ranking. Be specific.
  • Explain whether the measure is risk adjusted or not. If so, explain briefly how this is accomplished.
  • Describe how goals might be set for each measure in an aggressive organization, which is seeking to excel in the marketplace. Be specific and provide examples.
• Describe the importance of each rate-based measure to a chosen clinical organization and setting.
  • Using the websites and resources, you can choose a hospital, a nursing home, a home health agency, a dialysis center, a health plan, an outpatient clinic, or private office; a total population of patient types is also acceptable, but please be specific as to the setting. That is, if you are interested in patients with chronic illness across the continuum of care, you might home in a particular health plan, a multispecialty practice setting or a healthcare organization with both inpatient and outpatient/clinic settings.
  • Note: Faculty appointments and academic settings are not permitted for this exercise. For all other settings, consult the Instructor for guidance. You do not need actual data from a given organization to complete this Assignment.
• Explain how each rate-based measure (you selected) relates to patient safety, to the cost of poor quality, and to the overall cost of healthcare delivery. Be specific and provide examples.

Tools for Measuring Quality

Irrespective of their health conditions, all patients require timely,

effective, and quality health care services. Overall, achieving the desired state of health care quality remains a leading goal of health care organizations. Processes, procedures, and routine interactions should ensure that patients are excellently served. Satisfaction should be a guiding principle. In health practice, quality of care represents the degree to which health services meet the desired outcomes. To examine whether they are providing quality care, organizations should regularly evaluate their performance using rate-based quality measures. Evaluating performance guided by rate-based quality measures is a practical way of improving care delivery and patient outcomes. This paper describes rate-based measures of quality in health care organizations. It further deconstructs each measure, describes the importance, and explains how each measure relates to patient safety and the cost of healthcare delivery.

Rate-Based Measures: Description

Quality measures are reliable indicators of a healthcare organization’s capacity to deliver optimal care. Rates show the difference between performance and expectations. Appropriate rate-based quality measures for in-depth exploration include readmission rates, complication rates, and post-procedure death rates. These measures have been selected since they directly relate to the type of care that patients receive in health care settings. Their rates are inversely proportional to the quality of care. For instance, high readmission rates indicate that the quality of care does not meet the desired performance levels. The same case applies to complication rates and post-procedure death rates.

The other reason for selecting these measures is their significance in the overall health care provision in the United States. The Centers for Medicare & Medicaid Services (CMS) reports that quality health care is a priority for the President of the United States, Department of Health and Human Services, and CMS (Centers for Medicare & Medicaid, 2020). Due to the significance and interest of quality health care, CMS uses quality initiatives for health improvement in many instances and spends considerable resources in quality enhancement programs. As a result, the rate-based quality measures indicate the extent to which health care organizations align with the President’s and CMS’ expectations as far as quality is concerned.

Health care organizations require tools for quantifying healthcare processes. The selected rate-based measures are used for quantifying outcomes. Quantifying the processes and outcomes shows an organization’s ability to provide high-quality care. Quantifying outcomes by rating them also indicates the areas requiring more attention as the organization adopts new quality improvement mechanisms.

Deconstructing Each Measure

When a patient visits a healthcare organization for medical assistance, the general desire is to get an accurate diagnosis and proper treatment. Such assistance promotes healing and helps the patient to recover within the healthcare facility or at home. Unfortunately, health complications may necessitate readmission. Upadhyay et al. (2019) described readmission rate as hospital admission occurring within a specified time frame after discharge from the first admission. As a result, the readmission rate denotes the percentage of patients readmitted after discharge. Readmission rates may be calculated in terms of weeks, months, or annual readmission.

With hospital-acquired infections (HAIs) a sincere concern in health care delivery, the complication rate should guide health care providers in preventing HAIs. Lim (2019) described the complication rate as the percentage of patients developing complications resulting from care. In most instances, complication rates are high in complex procedures such as surgeries. For instance, the complication rate associated with heart surgeries is often higher than treatment for malaria. Routinely, many health care organizations track the complication rate by a specific timeframe or division. In this case, all complications can be calculated together or segmented according to the type of disease. The extent of complication rate indicates the quality of care that patients receive in a particular health care setting.

After the treatment, patients always look forward to a full and speedy recovery. Healthcare organizations also implement the necessary measures to prevent deaths to ensure that the mortality rates for all illnesses are as low as possible. Despite these efforts, deaths still occur after procedures. According to Lim (2019), the post-procedure death rate is the number of deaths occurring after treatment. The death rate usually varies depending on the procedure. Like readmissions and complication rates, a high post-procedure death rate may be an indicator of low-quality health services.

To construct the readmission rate, the number of readmitted patients (numerator) is divided by the number of patients served during a given period (denominator). The figure is given in percentage. For instance, if five patients were readmitted after 200 discharges, the readmission rate would be (5/200) x 100, giving 2.5%.  The complication rate is constructed by dividing the number of patients who develop complications by the number who received care in a given timeframe. The post-procedure death rate is calculated by dividing the number of deaths by the number of patients who received treatment. The post-procedure death rate is provided for each procedure. Like complication rates, post-procedure death rates differ depending on the type of procedure.

In each case, comparative data analysis occurs to develop the measure and get the necessary meaning to guide decision-making. For readmission rates, health care organizations may opt to record readmission cases for all illnesses after discharge. Alternatively, they may collect data for specific illnesses, which helps to determine illnesses associated with the highest readmission rates. The same approach can be used for collecting data for complication rates. Data may be case-specific or combine all complications over a given timeframe.  Post-procedure death rates’ data can be tracked hospital-wide or for specific divisions and health care teams.

To determine whether a healthcare organization’s performance is within the expected performance levels, data comparison is necessary. According to the Centers for Medicare & Medicaid Services (2020), quality measures should be publicly reported. As a result, health care organizations make their data public when required, implying that their performance is visible to other settings in the same state or different regions. Shah et al. (2019) noted that the availability of such performance data, including readmission rates, allows the Readmissions Reduction Program (HRRP) to incentivize decreased readmissions. A healthcare organization can do comparative performance analysis to reflect on its performance versus other organizations through the publicly reported data.

The rates can be provided as actual figures or percentile ranking. Like illustrated in readmission, complication, and post-procedure death rate calculations, actual rates represent the figures of each measure calculated using historical operating functions and adjustment factors. For instance, the actual readmission rate is the number of readmissions divided by the number of discharges in a given time. Mostly, actual rates are given in percentage. On the other hand, percentile ranking is the percentage of scores in the frequency distribution equal or lower than the score. For instance, if the readmission rate is 65% of a hospital, 65 is the percentile rank. Since readmissions illustrate poor performance, the facility would have performed worse than 65% of other facilities included in the frequency distribution.

Some measures of quality are usually risk-adjusted. For accurate calculations of post-procedure death rate, the measurement must factor the risk level into calculations (Ng-Kamstra et al., 2018). The risk level varies for each procedure. Risk adjustment also applies to complication and readmission rates. Risk adjustment includes risk factors associated with a measure score, allowing fair and accurate healthcare outcomes comparison. A typical risk factor is the health status of a patient.

Healthcare organizations set different goals based on their missions, visions, and performance objectives. For an aggressive organization seeking to excel in the marketplace, a reasonable goal for readmission rate as a measure of quality is to reduce the rates to below the state and nationally minimum allowable levels. As a result, the organization would adopt the necessary measures to reduce the rates, such as bedside patient education and technology adoption in healthcare processes for better communication and patient monitoring.  For complication rate, an aggressive organization would set quality improvement goals focusing on reducing the complication rate. As a result, the organization would initiate measures to prevent complications after a medical procedure. Similar goals apply to the post-procedure death rate. The organization should be motivated to have no death case after a medical procedure. The reference point should always be the state and national performance benchmarks.

References

Brunner-La Rocca, H. P., Peden, C. J., Soong, J., Holman, P. A., Bogdanovskaya, M., & Barclay, L. (2020). Reasons for readmission after hospital discharge in patients with chronic diseases—Information from an international dataset. PloS One, 15(6), e0233457. https://doi.org/10.1371/journal.pone.0233457

Centers for Medicare & Medicaid Services. (2020, Feb 11). Quality measures. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures

Gupta, S., Zengul, F. D., Davlyatov, G. K., & Weech-Maldonado, R. (2019). Reduction in hospitals’ readmission rates: Role of hospital-based skilled nursing facilities. Inquiry : A Journal of Medical Care Organization, Provision and Financing, 56, 46958018817994. https://doi.org/10.1177/0046958018817994

Lim, R. (2019). Multidisciplinary approaches to common surgical problems. Springer Nature.

Merkow, R. P., Shan, Y., Gupta, A. R., Yang, A. D., Sama, P., Schumacher, M., … & Bilimoria, K. Y. (2020). A comprehensive estimation of the costs of 30-day postoperative complications using actual costs from multiple, diverse hospitals. The Joint Commission Journal on Quality and Patient Safety, 46(10), 558-564. https://doi.org/10.1016/j.jcjq.2020.06.011

Ng-Kamstra, J. S., Arya, S., Greenberg, S. L., Kotagal, M., Arsenault, C., Ljungman, D., … & Shrime, M. G. (2018). Perioperative mortality rates in low-income and middle-income countries: a systematic review and meta-analysis. BMJ Global Health, 3(3), e000810. http://dx.doi.org/10.1136/bmjgh-2018-000810

Shah, R. M., Zhang, Q., Chatterjee, S., Cheema, F., Loor, G., Lemaire, S. A., … & Ghanta, R. K. (2019). Incidence, cost, and risk factors for readmission after coronary artery bypass grafting. The Annals of Thoracic Surgery, 107(6), 1782-1789. https://doi.org/10.1016/j.athoracsur.2018.10.077

SLC Health Saint Joseph. (2021). Our services. https://www.sclhealth.org/locations/saint-joseph-hospital/

Upadhyay, S., Stephenson, A. L., & Smith, D. G. (2019). Readmission Rates and Their Impact on Hospital Financial Performance: A Study of Washington Hospitals. Inquiry : A Journal Of Medical Care Organization, Provision and Financing, 56, 46958019860386. https://doi.org/10.1177/0046958019860386

Warchol, S. J., Monestime, J. P., Mayer, R. W., & Chien, W. W. (2019). Strategies to Reduce Hospital Readmission Rates in a Non-Medicaid-Expansion State. Perspectives in Health Information Management, 16(Summer), 1a. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6669363/