The healthcare industry is riddled with administrative and regulatory complexities that make it difficult for health systems to achieve the Triple–or better yet, the Quadruple–Aim of healthcare. The complexities found in outcomes improvement are particularly challenging, as health systems measure and report on hundreds of these outcomes annually. Health systems can manage these complexities by taking a closer look at outcome measures—understanding their definitions and nuances, reviewing real-world examples, and integrating three essentials for successful outcomes measurement.

Why Measuring Healthcare Outcomes Is Important

The goal of measuring, reporting, and comparing healthcare outcomes is to achieve the Quadruple Aim of healthcare:

1. Improve the patient experience of care.
2. Improve the health of populations.
3. Reduce the per capita cost of healthcare.
4. Reduce clinician and staff burnout.

The organization behind the Triple Aim—the Institute for Healthcare Improvement (IHI)—is dedicated to outcomes improvement. IHI describes measurement as “a critical part of testing and implementing changes. Measures tell a team whether the changes they are making actually lead to improvement.” The fourth aim may vary depending on the organization.

Healthcare organizations–motivated by the Quadruple Aim–measure outcomes for several reasons

Reveal areas in which interventions could improve care, Identify variations of care, Provide evidence about interventions that work best for certain types of patients under certain circumstances, Compare the effectiveness of various treatments and procedures.

Outcome Measures Defined                                                                                                            

The World Health Organization defines an outcome measure as a “change in the health of an individual, group of people, or population that is attributable to an intervention or series of interventions.” Outcome measures (mortality, readmission, patient experience, etc.) are the quality and cost targets healthcare organizations are trying to improve.

Outcome measures are frequently reported to the government, commercial payers, and organizations that report on quality, such as The LeapFrog Group—a national nonprofit that evaluates and reports U.S. hospital safety and quality performance. LeapFrog’s work centers on “increasing transparency among health care providers in order to reduce the estimated 440,000 annual deaths from hospital errors, accidents, and injuries.” While initial measures focused on inpatient care, they have since expanded to include most aspects of care delivery.

Outcome Measures Are Driven by National Standards and Financial Incentives

Outcome measures are primarily defined and prioritized by national organizations, including CMS, The Joint Commission, and the National Association for Healthcare Quality (NAHQ). Health systems target outcome measures based on state and federal government mandates, accreditation requirements, and financial incentives.

Although healthcare outcomes and targets are defined at the national level, health systems might set more aggressive targets. Meeting and exceeding these national targets, benefits not only quality of care, but also healthcare organizations’ marketing and contracting efforts.

The Joint Commission is a regulatory body that accredits health systems and has national standards for quality measures that are “developed with input from healthcare professionals, providers, subject matter experts, consumers, government agencies (including CMS) and employers.” New standards must meet the following strict requirements:

Relate to patient safety or quality of care, Positively impact healthcare outcomes, Meet or surpass law and regulation, Can be accurately and readily measured.

1. Mortality (22 percent)
2. Safety of care (22 percent)
3. Readmissions (22 percent)
4. Patient experience (22 percent)
5. Effectiveness of care (4 percent)
6. Timeliness of care (4 percent)
7. Efficient use of medical imaging (4 percent)