3-Point Framework for Expanded Outpatient Quality Measurement
Journal of the American Medical Association.
Currently, most outpatient measures focus on preventive care and chronic disease management and fail to include measures of safety, effectiveness, coordination and efficiency. This narrow view of quality may cause providers to focus less on other important facets of quality, which may reduce overall quality. To change this limited measurement of outpatient quality, the author suggests a new framework that is more inclusive of different aspects of quality. She suggests the following measures:
• Safety. Safety measures can include never events, such as medication errors, failure to inform patients of test results, healthcare-acquired infections and failure to monitor for adverse effects of treatments.
• Preventive and chronic disease care. This measure includes process measures such as rates of vaccination, preventive cancer screening and use of chronic medications.
• High level of quality. This measure includes diagnostic accuracy, appropriate use of resources and treatment decisions for rare or complex diseases. Surrogate measures, such as physician reputation, physician training or patients' trust in their physicians, may indicate outpatient quality if research shows a correlation between these measures and more objective measures of high-quality care, according to the author.
The outpatient community should focus more on the first and third measures, as the second — preventive and chronic disease care — is already well represented in quality measures, according to the perspective piece.
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