Quality measurement in health care is the process of using data to evaluate the performance of health plans and health care providers against recognized quality standards.

 

Quality measures can take many forms, and these measures evaluate care across the full range of health care settings, from doctors’ offices to imaging facilities to hospital systems.

Measuring the quality of health care is a necessary step in the process of improving health care quality. Too often, the quality of care received in the United States is substandard: Patients receive the proper diagnosis and care only about 55 percent of the time,1 and wide variations in health care quality, access, and outcomes persist.2 Research consistently shows that there is chronic underuse, overuse, and misuse of services. Furthermore, the way health care is delivered is often fragmented, overly complex, and uncoordinated. These problems can lead to serious harm or even death.

 

Quality measurement can be used to improve our nation’s health care by: 1) preventing the overuse, underuse, and misuse of health care services and ensuring patient safety; 2) identifying what works in health care—and what doesn’t—to drive improvement; 3) holding health insurance plans and health care providers accountable for providing high-quality care; 4) measuring and addressing disparities in how care is delivered and in health outcomes; and 5) helping consumers make informed choices about their care.

TYPE 

DESCRIPTION 

EXAMPLE 

Structure 

Assesses the characteristics of a care setting, including facilities, personnel, and/or policies related to care delivery. 

Does an intensive care unit (ICU) have a critical care specialist on staff at all times? 

Process 

Determines if the services provided to patients are consistent with routine clinical care. 

Does a doctor ensure that his or her patients receive recommended cancer screenings? 

Outcome 

Evaluates patient health as a result of the care received. 

What is the survival rate for patients who experience a heart attack? 

Patient Experience 

Provides feedback on patients’ experiences of care. 

Do patients report that their provider explains their treatment options in ways that are easy to understand?