Current quality measures are expensive and time consuming to report, and they don’t necessarily improve care. Many health systems are looking for better ways to measure the quality of their care, and they are using data analytics to achieve this goal. Data analytics can be helpful with quality improvement. There are four key considerations to evaluate quality measures: Organizations must develop measures that are more clinically relevant and better represent the care provided. Clinician buy-in is critical. Without it, quality improvement initiatives are less likely to succeed. Investment in tools and effort surrounding improvement work must increase. Tools should include data analytics. Measure improvement must translate to improvement in the care being measured. When the right measures are in place to drive healthcare improvement, patient care and outcomes can and do improve.

1. Improving Quality Measures Can Lead
to Better Outcomes

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The Digitization of Healthcare
This report is based on a 2018 Healthcare Analytics Summit presentation
given by Christian Dankers, MD, MBA, Associate Chief Quality Officer,
Partners HealthCare, Harvard Medical School Faculty, entitled, “Real Quality:
A Recipe for Healthier Patients and Happier Doctors.”
Christian Dankers, MD
Partners HealthCare

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In the United States, each year physician
practices spend $15.4 billion and individual
physicians spend 785 hours to report quality
measures, according to a March 2016 study
in Health Affairs.
It’s clear there is a lot of emphasis on quality
measurement, yet current quality measures
aren’t doing enough to drive care and
outcome improvement.
With this in mind, health systems are
examining measures and how to improve
them so they more accurately reflect the
quality of care, have clinician buy-in, and
lead to better care.
Healthcare Outcomes Improvement

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Quality measurement in its current state is used in four general ways:
To inform clinical care (quality improvement)
To ensure meeting a minimum standard (regulatory)
To inform decision making (transparency)
To incentivize behaviors (pay for performance and transparency)
Shortcomings of Current Quality Measures
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This approach presents several limitations.
It is both expensive and time consuming, as
noted in the Health Affairs study cited above.
Additionally, according to that same 2016
study, most physicians don’t believe that
the measures represent true quality of care
and don’t use those measures to inform
care practices.
Shortcomings of Current Quality Measures

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Measures also fall short in capturing the
scope of care that needs to be measured
and improved, focusing largely on hospitals
and primary care practices.
Ambulatory care and patient-reported
outcome measures (PROMs) aren’t included
in current quality measures, which leaves
patients and consumers with an incomplete
picture of the care provided by different
physicians at various healthcare facilities.
Shortcomings of Current Quality Measures

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Many healthcare organizations are
rethinking quality measurement.
With the goal of improving measures and,
ultimately, improving care, organizations
are looking at new ways to measure care
provided that will increase the positive
effects of measurement.
The Triple Aim Plus One can inform
stronger measure development that
leads to meaningful care improvement.
Translating Better Quality Measures to Better Care

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Based on the IHI Triple Aim, this system expands to include
both patient and clinician-oriented experiences.
Look at the Triple Aim Plus One framework:
Population health (mortality rate, disease burden,
and health/functional status)
Per capita cost (total cost per member per month)
Experience of care (patient experiences, patient
safety, and healthcare effectiveness)
Translating Better Quality Measures to Better Care
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Plus One:
Clinician satisfaction (because all other
parts of the triple aim depend upon an
engaged clinician workforce)
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But simply developing new measures is not
enough. The best measurements in the world
are meaningless without a way to translate
those measures into better care.
Four aspects are critical to the process of
moving from improved measurement to
improved care and outcomes:
More clinically relevant quality measures.
Increased buy-in from clinicians.
Increased investment in tools and the
effort around the improvement work.
Demonstrated improvement in clinically
relevant measures.
Translating Better Quality Measures to Better Care
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Clinically relevant quality measures should follow a set of standards:
More Clinically Relevant Quality Measures
Unifying
Measures must have buy-in from stakeholders and
represent the core mission
Motivating
Poor performance against the measures should
concern stakeholders
Accurate
Measures should accurately represent the delivery of
care and related outcomes
Available
Data for the measures must be accessible and not
excessively costly to gather
Actionable
Stakeholders should be able to easily use measures to
guide discussion and initiate change
Balanced and
parsimonious
There should be a limited number of measures to
convey what clinicians (and patients) need to know

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Having buy-in from clinicians is key to quality
measures that improve care.
Measures that are more clinically relevant and
that providers and stakeholders agree better
represent the care provided may help spark
buy-in from clinicians.
Increased Buy-In from Clinicians

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The Importance of Meaningful Measurement
One way to get clinicians to see value in quality
measurement is to have meaningful measures.
Using the EHR to gather data and using data
analytics and electronic tools to demonstrate value
can make measures more relevant and actionable.
Using the EHR for data collection tends to lead to
more accurate, actionable measures than claims-
based, HEDIS measures.
EHRs are ripe with actionable data just waiting
to be analyzed and used for improvement.
Increased Buy-In from Clinicians

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The Importance of Meaningful Measurement
Electronic tools are also important:
Increased Buy-In from Clinicians
DATA ANALYSIS TOOLS
Include several benefits for
quality measurement. For
example, they allow bench-
marking and evaluation of both
individual physicians and entire
practices. Data analysis tools
can give health systems the
ability to leverage data to
improve care and operational
efficiency while reducing costs.
PREDICTIVE
MODELING TOOLS
Allows teams to understand the
likelihood that measures will
yield benefits. For example,
using predictive modeling, an
organization can look at a
specific population to see
whether smoking cessation
activities are predicted to
reduce risk of heart attack
or mortality.
SHARED DECISION
MAKING TOOLS
Allows patients and physicians
to look together at data about
risks and benefits of treatment
options, which can inform
development of an
individualized treatment plan.
And this ultimately can help
improve outcomes.

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Sustained, meaningful change in quality measurement
takes investment both in tools and in an effort.
Investing in the tools to help meet quality improvement
goals is critical. Investing in effort is important as well.
Effort must come in many forms:
effort to engage leaders
effort to increase transparency,
effort to design incentives that work
effort to ensure policies, measures, training
and education, and tools are focused on
quality improvement and better patient care
Increased Investment in Quality Measurement
Tools and Effort
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Transparency is an important part of quality
improvement initiatives because it tends to build trust
with consumers and hold providers accountable.
Investing in tools that aid in transparency can help
translate new measures into better care. There are
several tools that can improve transparency:
Webpages that publish quality measure results
Open notes that allow patients to see their
own medical records
PROMs publication tools
Increased Investment in Quality Measurement
Tools and Effort
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Webpages that publish quality measure results
For example, Press Ganey patient rating
information can improve transparency by
providing information about patient
experiences throughout the organization.
Increased Investment in Quality Measurement
Tools and Effort

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Open notes that allow patients to see their own medical records
Patients have a quick and easy way to see what’s
in their health records.
This not only improves transparency, but it can
help patients become more invested in their
own care, which tends to improve outcomes.
Increased Investment in Quality Measurement
Tools and Effort

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PROMs publication tools
These give patients an insider’s view of how
other patients report their care outcomes.
When patients know their healthcare providers
are being transparent, it helps improve trust
and the patient/provider relationship.
Increased Investment in Quality Measurement
Tools and Effort

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Knowledge is empowering.
Training leaders in the work and culture of
improvement and making sure they have the
skills and tools to support change and improve
is a first step toward meaningful change.
When leaders are on board and prepared,
offering training throughout the organization
helps create a culture of improvement.
Once organizations have the right tools, making
measurable improvements becomes easier.
Increased Investment in Quality Measurement
Tools and Effort

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Investing in quality improvement efforts is not
optional for health systems.
The push for improving care while cutting
costs is ongoing, and health systems are
under great pressure to perform.
Developing measures that are clinically
relevant and representative will help get
clinicians on board.
Demonstrated Improvement on Clinically
Relevant Quality Measures

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Getting clinicians on board will help improve
outcomes because they will be more likely to
use data to inform care.
When patients and clinicians can see how
data relates to outcomes, they tend to be more
informed and invested in care.
A culture focused on quality improvement must
continually reevaluate measures and approach
to ensure the measures are doing what they
set out to do – drive improvement in care.
Demonstrated Improvement on Clinically
Relevant Quality Measures

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By continually re-evaluating measures and the approach to
quality measurement, measures can lead to better patient care.
When measures are clinically relevant, clinicians are engaged,
and everyone has the tools they need to drive improvement,
outcomes and patient care can and do improve.
Demonstrated Improvement on Clinically
Relevant Quality Measures

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For more information:
“This book is a fantastic piece of work”
– Robert Lindeman MD, FAAP, Chief Physician Quality Officer

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More about this topic
Link to original article for a more in-depth discussion.
Improving Quality Measures Can Lead to Better Outcomes
Why We Need to Shift Healthcare Quality Measures from Volume to Value
Jared Crapo, Sales, Sr. VP
Five Strategies for Easing the Burden of Clinical Quality Measures
Britney Rosenau , Regulatory Operations Reporting Director
How to Determine the Best Interventions for Clinical Quality Improvement Projects
Kathleen Merkley, DNP, APRN, FNP, Sr. VP of Professional Services
Ann Tinker, MSN, RN, Sr. VP Professional Services
A Guide to Applying Quality Improvement to Healthcare: Five Principles
Lloyd Provost
3 Steps to Prioritize Clinical Quality Improvement in Healthcare
Bobbi Brown, MBA, Sr. VP

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Other Clinical Quality Improvement Resources
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