The importance of measuring how we reach efficient outcomes

We have already discussed the importance of measuring outcomes: Medicare uses the "functional outcomes" data on claims submitted by physical therapists and other providers to determine the need for services, the quality of care, and the value of the service received by the beneficiary.

But tracking outcome measures alone is not always sufficient to reach the goals of better quality and efficient costs. Providers must also track the evidence-based process measures that drive better outcomes.

What exactly are these evidence-based process measures? First, it helps to understand the three types of measures we use in healthcare analytics:

Outcome measures: These are the quality and cost targets you are aiming at improving; they are often reported to government and commercial payers. Some examples of metrics for outcome measures include mortality rates, readmissions rates, and surgical site infection rates.

Balance measures: These are the metrics a health system or provider must track to ensure that an improvement in one area isn’t negatively impacting another area. For a hospital-related example, let’s say length of stay (LOS) in labor and delivery is the outcome metric. The hospital wants to reduce LOS and save money. The balance metric might be patient satisfaction. If mothers feel rushed toward discharge, outcome there might be a negative impact on patient satisfaction even while improving LOS.

Process measures: These measures are the specific steps in a process that lead, either positively or negatively, to a particular outcome metric. For example, let’s say the outcome measure is LOS. A process metric for that outcome might be the amount of time that passes between when the physician ordered the discharge and when the patient was actually discharged. You might then look at the turnaround time between final take-home medication being ordered and medication delivery to the unit. If it takes the pharmacy three hours to get the necessary medications to the floor — potentially delaying the discharge — you’ve pinpointed a concrete opportunity for healthcare process improvement.

Process measures used by physical therapists essentially represent a provider’s efforts to incorporate evidence-based best practices into its improvement efforts; they improve quality and cost by enabling organizations to reduce the amount of variation in care delivery. An example: the patient complains of pain. You need to find the source and alleviate it. You need to do it efficiently and effectively; that’s your outcome measure. How are you actually going to drive improvement? Simply by implementing and tracking the right process metrics.

Process measures in this example are the steps that should be performed every time the patient experiences the specific pain. The plan of treatment will be journalized, and the results of each

step recorded. You are thus measuring the effectiveness of your treatment process; very soon, the "weak link" in your treatment plan will make itself visible.

By tracking process measures, you can pinpoint the root cause of previous failures. If you don’t have a well-designed process in place to treat patient pain, it should be no surprise if you don’t perform well on that outcome metric.


American Physical Therapy Association