U.S. healthcare facilities are improving more rapidly on process measures than they are on clinical outcome measures, according to a new CMS report. Overall, the nation saw improvement on most of the publicly reported measures evaluated between 2006 and 2013.
The 2015 National Impact Assessment (PDF), posted Monday, is a comprehensive evaluation of the effects of hundreds of measures used across a total of 25 CMS quality-reporting programs for hospitals, nursing homes, home health agencies and clinician offices.
The report found that of 119 publicly reported measure rates across seven quality-reporting programs, 95% showed improvement between 2006 and 2012. A total of 41 measures were classified as “high performing.” That translates to performance rates exceeding 90% in the three final years for which data were available.
Process measures were most likely to reach the high performer level with 34 out of the 41. Process measures look at how well facilities follow clinical guidelines while clinical outcome measures look at how patients actually fare.
Between 7,000 and 10,000 lives were saved through improved performance on inpatient hospital heart-failure process measures, for example, and 4,000 to 7,000 infections were averted through improved performance on inpatient hospital surgical process measures during the period studied.
However, only six of the high performance measures addressed clinical outcomes.
“Process measures may have a limited lifespan, since performance benchmarks are more rapidly achieved,” the report said.
Programs evaluating hospitals, including, the outpatient and inpatient quality-reporting programs, had the largest percentage of process measures, compared to programs focused on ambulatory- and post-acute-care settings.
Concern over how best to include process measures has been an issue for patient-safety leaders. Processes are meaningful to help track how efficiently care is being provided, and they are easier to measure.
The scientific and measurement aspects needed to ensure that clinical outcome measures provide meaningful data have not all been worked out, safety leaders told Modern Healthcare in November.
The new CMS report also found that more than 700 new quality measures were added between 2006 and 2013. The additions were due, in part, to an increase in the number of federal evaluation programs, which expanded from five to 25 during that time period.
The analysis includes the Hospital Value-Based Purchasing, Hospital-Acquired Condition Reduction, Nursing Home Quality Initiative and Home Health Quality Reporting programs, among others.
A section of the Affordable Care Act mandates that this assessment of the quality and efficiency effects of the endorsed CMS measures be conducted at least once every three years. The next is anticipated in 2018.
The report was developed by the Health Services Advisory Group, an external quality improvement organization, and the RAND Corp., a not-for-profit research organization.
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