Healthcare Performance Measurement & Improvement

You cannot manage what you cannot measure. In the case of healthcare, communities must be able to identify opportunities for reducing costs and improving quality, and monitor whether those opportunities are being successfully addressed. 

RHICs can serve as a trusted source of actionable information about the cost and quality of healthcare services, the health of the population, and/or the extent to which innovative methods of delivery, payment, and health promotion are being used in their community.

Measurement

RHICs across the country are publishing reports on many aspects of quality and cost that are unavailable to the public and healthcare providers through any other source. These measurement and reporting initiatives are developed and operated with the active involvement  of the physicians and hospitals whose performance is being measured, who ensure that the measures are meaningful and the data – accurate. 

Types of Performance Measurement: quality of physician services, quality of hospital services, quality of health plans, patient experience of care, cost of healthcare services, disparities in performance.

Quality of Physician Services

Most RHICs collect and publicly report data on the quality of care delivered by physician practices. The types of measures reported include both clinical processes of care (e.g., did all diabetic patients receive a test to measure their level of blood sugar?) and care outcomes (e.g., how many diabetic patients had well-controlled blood sugar levels?), as well as patient experience of care.

Quality of Hospital Services

A number of Regional Health Improvement Collaboratives also report on the quality of care delivered in the hospitals in their community. The measures range from processes (e.g., how quickly heart attack patients were treated) to outcomes (e.g., infection rates and mortality rates).

Quality of Health Plans

Many RHICs also report on the quality of care delivered to patients who have health insurance from a specific health plan. 

Some RHICs also are developing and producing health plan performance measures for the state-level Health Insurance Exchanges.

Patient Experience of Care

A  growing number of RHICs are also collecting and reporting information that focuses on consumers’ experience with healthcare services.

Cost of Healthcare Services

Some RHICs are developing measures of the cost of healthcare services, such as the prices charged for individual services, the extent to which the most cost-effective services are used, and the total number of services used to address a particular healthcare issue.

RHICs CONTRIBUTION TO PERFORMANCE IMPROVEMENT

Many Regional Health Improvement Collaboratives, for example Better Health Greater Cleveland, have programs designed to help providers, either individually or in groups, to better organize and deliver healthcare in order to improve quality and efficiency.

Several Collaboratives, including Comagine Health in Nevada and Utah, the Louisiana Health Care Quality Forum, the Pittsburgh Regional Health Initiative, and Qualidigm, are helping physician practices become patient-centered medical homes, implement electronic health records, and more effectively coordinate care with other providers. The Iowa Healthcare Collaborative is transforming primary care in Iowa through its Medical Home Learning Community and Medical Home System Advisory Council.

Below we provide more detailed examples of our members’ work on performance improvement. 

The Pittsburgh Regional Health Initiative (PRHI) pioneered the adaptation of “lean” manufacturing from the Toyota Production System so that they could be successfully used to improve quality and reduce costs in healthcare. PRHI’s Perfecting Patient Care ℠(PPC) system has been used by hospitals, physicians, nursing homes, and other providers all over the country to achieve dramatic reductions in hospital-acquired infections, preventable hospital readmissions, pre-term deliveries of babies, and many other areas that benefit patients and reduce healthcare costs. PRHI’s  Tomorrow’s Healthcare ℠ program brings Perfecting Patient Care tools to a web-based platform.

The Institute for Clinical Systems Improvement has developed and maintains an extensive array of guidelines for healthcare services based on the best evidence available, and then it works to help healthcare providers implement the guidelines and make other improvements in their own organizations.

The Patient-Centered Primary Care Institute, a public-private partnership between the Oregon Health Care Quality Corporation and the Oregon Health Authority, helps providers and practices achieve improvements in quality, access, coordination, patient experience and clinical outcomes – and thereby fulfill Oregon’s vision for the Triple Aim outcomes. Providers, clinic staff, technical experts, patient advisers, quality improvement professionals, policymakers and academic centers – all collaborate to advance and share knowledge and resources.  Visit www.pcpci.org to learn more about the Institute and find valuable practice transformation resources, including a series of webinar trainings.

GDAHC partnered with the Michigan Chapter of the American College of Cardiology (ACC) and MPRO, Michigan’s Quality Improvement Organization, to launch the southeast Michigan “See You in 7” hospital collaborative. The purpose of the Collaborative was to improve the early follow-up process for heart failure patients. The goal of the Collaborative was to reduce readmissions. The Collaborative focused on process measures from the ACC’s toolkit to increase the number of follow-up appointments within seven days of discharge.  MPRO provided data for the Collaborative, which showed that the ten hospitals participating in the Collaborative were able to reduce readmissions by 9.5% compared to 4.9% for other hospitals in the state. Details of the Collaborative are available at www.gdahc.org.

GDAHC’s initiative focuses on reducing use of Emergency Departments for conditions that are better treated by a Primary Care Physician (PCP). Strategies include expansion of a GDAHC pilot that successfully showed there are simple actions PCPs can take, such as revising their after-hours telephone script, ensuring a written triage policy for urgent visits that all staff follow and ensuring patients are aware of ways to access PCP advice after-hours. In GDAHC’s pilot, PCP practices reduced their patients’ use of EDs for PCP treatable conditions from a high of 49.2 visits/1000 to just 7.3 visits/1000 at the end of the four-month project. In addition to PCP actions, GDAHC has a campaign to educate consumers about appropriate settings of care; GDAHC created a Stoplight poster, brochure and presentation that can be used to educate consumers. GDAHC printed 5,000 Stoplight posters of various sizes and is in the process of distributing them throughout the region to be displayed in physician practices, employee lunchrooms and other settings throughout the community so consumers get a consistent and repeated message. More information and details about the PCP pilot are available at www.gdahc.org.

New Jersey Health Care Quality Institute's work is improving health in communities across New Jersey.

  • CTHA's Work on Primary Care
Briefing Highlights on Efforts to Improve Quality in Primary Care Practices through Common Table Health Alliance's Project Better Care in Memphis and Shelby County Tennessee

This briefing highlights the findings of the Alliance's report on primary care in Memphis and Shelby County entitled and how quality improvement and effective delivery of primary care can prevent emergency department (ED) visits for patients with type 2 diabetes. The report is entitled, “Status Report on Efforts to Improve Quality in Primary Care Practices through HMCT’s Project Better Care in Memphis and Shelby County, Tennessee,”  from its Take Charge for Better Health® Series.  Download
A  growing number of RHICs are also collecting and reporting information that focuses on consumers’ experience with healthcare services. For example:
  • In 2013, Minnesota Community Measurement released the results of the nation’s first and largest statewide patient experience survey. It included more than 230,000 patient-completed surveys on patient experience of care from 651 clinics around Minnesota. It utilized the CG-CAHPS survey, a national standard for objective reporting of patient experience and the results were posted on MNCM’s MN HealthScores website (link to http://www.mnhealthscores.org). The next round of results will be released in 2015.
Regional Health Improvement Collaborative reports on patient experience:  Albuquerque, Detroit, Iowa,Massachusetts, Memphis, Minnesota, Seattle, Health Care Improvement Foundation, Wisconsin
Quality of Hospital Services
A number of Regional Health Improvement Collaboratives also report on the quality of care delivered in the hospitals in their community. Here again, the measures range from processes (e.g., how quickly heart attack patients were treated) to outcomes (e.g., infection rates and mortality rates). For example: RHIC reports on the quality of hospital services: Albuquerque, Cleveland, DetroitIowa,  MaineMemphisMinnesotaNevadaOregonSeattle,  UtahWest MichiganWisconsin
Cost of Healthcare Services
Some RHICs are developing measures of the cost of healthcare services, such as the prices charged for individual services, the extent to which the most cost-effective services are used, and the total number of services used to address a particular healthcare issue. For example:
  • Minnesota Community Measurement reports on the costs at different healthcare providers for procedures ranging from colonoscopies to labor and delivery
  • Quality Quest for Health reports on the rate at which physicians prescribe generic drugs for their patients. Generic prescribing rates are reported for primary care physicians and a number of specialties.
  • Washington Health Alliance was chosen by the state of Washington's Bureau of Insurance to produce transparent pricing information. Read article
Regional Health Improvement Collaborative reports on cost of healthcare services:  Detroit,Memphis, Minnesota, Rochester/Finger Lakes, Wisconsin
Quality of Physician Services
Most Regional Health Improvement Collaboratives collect and publicly report data on the quality of care delivered by physician practices. The types of measures reported include both clinical processes of care (e.g., did all diabetic patients receive a test to measure their level of blood sugar?) and care outcomes (e.g., how many diabetic patients had well-controlled blood sugar levels?), as well as patient experience of care. Most of these measurement systems rely on health plan claims data, but some include clinical data.

The Wisconsin Collaborative for Healthcare Quality has pioneered a methodology to obtain clinical data directly from physicians, thus enabling more comprehensive quality measurement. This methodology does not depend on physicians having electronic health record systems, thereby allowing broad-based participation. Similar approaches are now being used by other RHICs, such as Minnesota Community Measurement and The Health Collaborative.
RHIC reports on the quality of physician services: Albuquerque, Cleveland, Detroit, Massachusetts, Memphis, Minnesota,  St. Louis, Seattle, West Michigan, Wisconsin and others.
Quality of Health Plans
Many RHICs also report on the quality of care delivered to patients who have health insurance from a specific health plan. For example:
  • The Washington Health Alliance issues an extensive analysis of health plan quality and services, rating health plans on over three dozen different items.
Some RHICs also are developing and producing health plan performance measures for the state-level Health Insurance Exchanges.

Regional Health Improvement Collaborative reports on the quality of health plan services: Seattle, Utah, West Michigan, Wisconsin
Previous
Next
Improvement
Although measurement, reporting and changes in payment systems are necessary to support higher-value healthcare delivery, improvements in quality, efficiency, and patient satisfaction are actually achieved through the actions of front-line healthcare workers. Regional Health Improvement Collaboratives operate programs designed to improve the way that physicians, nurses, hospital administrators, and other healthcare professionals deliver care, ranging from identifying and disseminating best practices in care delivery, to providing affordable training, coaching, and technical assistance to practitioners on ways to analyze problems in care delivery and ways to design and successfully implement solutions, to helping healthcare providers reorganize and modernize their operations to support better-quality, more-affordable care. The Center for Medicare and Medicaid Services (CMS) Innovation Center launched a nationwide public-private collaboration called the Hospital Engagement Networks (HEN) to identify and create innovative solutions designed to reduce patient harm and improve care coordination. CMS awarded 26 organizations a two-year contract to help identify the key improvements and spread initiatives across their defined population.  The Iowa Healthcare Collaborative was awarded the sole Iowa-based contract to serve Iowa hospitals in this campaign. The 127 hospitals participating in the Iowa-based Hospital Engagement Network (HEN) prevented potential harm to more than 4,300 patients in 2013 and reduced health care costs by more than $51 million, according to data released by the Iowa Healthcare Collaborative (IHC), which administers the network.  Read more.
RHICs Contribution to Performance Improvement
Many Regional Health Improvement Collaboratives, for example Better Health Greater Cleveland, have programs designed to help providers, either individually or in groups, to better organize and deliver healthcare in order to improve quality and efficiency.

Several Collaboratives, including Comagine Health in Nevada and Utah, the Louisiana Health Care Quality Forum, the Pittsburgh Regional Health Initiative, and Qualidigm, are helping physician practices become patient-centered medical homes, implement electronic health records, and more effectively coordinate care with other providers. The Iowa Healthcare Collaborative is transforming primary care in Iowa through its Medical Home Learning Community and Medical Home System Advisory Council.
PRHI's Perfecting Patient Care
The Pittsburgh Regional Health Initiative (PRHI) pioneered the adaptation of “lean” manufacturing from the Toyota Production System so that they could be successfully used to improve quality and reduce costs in healthcare. PRHI’s Perfecting Patient Care ℠(PPC) system has been used by hospitals, physicians, nursing homes, and other providers all over the country to achieve dramatic reductions in hospital-acquired infections, preventable hospital readmissions, pre-term deliveries of babies, and many other areas that benefit patients and reduce healthcare costs. PRHI's  Tomorrow’s Healthcare ℠ program brings Perfecting Patient Care tools to a web-based platform.
New Jersey Health Care Quality Institute's work is improving health in communities across New Jersey.

Briefing Highlights on Efforts to Improve Quality in Primary Care Practices through Common Table Health Alliance's Project Better Care in Memphis and Shelby County Tennessee

This briefing highlights the findings of the Alliance's report on primary care in Memphis and Shelby County entitled and how quality improvement and effective delivery of primary care can prevent emergency department (ED) visits for patients with type 2 diabetes. The report is entitled, “Status Report on Efforts to Improve Quality in Primary Care Practices through HMCT’s Project Better Care in Memphis and Shelby County, Tennessee,”  from its Take Charge for Better Health® Series.  Download
ICSI Guidelines
The Institute for Clinical Systems Improvement has developed and maintains an extensive array of guidelines for healthcare services based on the best evidence available, and then it works to help healthcare providers implement the guidelines and make other improvements in their own organizations.
Achieving Oregon’s Vision for the Triple Aim
The Patient-Centered Primary Care Institute, a public-private partnership between the Oregon Health Care Quality Corporation and the Oregon Health Authority, helps providers and practices achieve improvements in quality, access, coordination, patient experience and clinical outcomes – and thereby fulfill Oregon’s vision for the Triple Aim outcomes. Providers, clinic staff, technical experts, patient advisers, quality improvement professionals, policymakers and academic centers – all collaborate to advance and share knowledge and resources.  Visit www.pcpci.org to learn more about the Institute and find valuable practice transformation resources, including a series of webinar trainings.
Greater Detroit Area Health Council Partners for "See You in 7"
GDAHC partnered with the Michigan Chapter of the American College of Cardiology (ACC) and MPRO, Michigan’s Quality Improvement Organization, to launch the southeast Michigan “See You in 7” hospital collaborative. The purpose of the Collaborative was to improve the early follow-up process for heart failure patients. The goal of the Collaborative was to reduce readmissions. The Collaborative focused on process measures from the ACC’s toolkit to increase the number of follow-up appointments within seven days of discharge.  MPRO provided data for the Collaborative, which showed that the ten hospitals participating in the Collaborative were able to reduce readmissions by 9.5% compared to 4.9% for other hospitals in the state. Details of the Collaborative are available at www.gdahc.org.
Greater Detroit Area Health Council's "ED Use" Initiative
GDAHC’s initiative focuses on reducing use of Emergency Departments for conditions that are better treated by a Primary Care Physician (PCP). Strategies include expansion of a GDAHC pilot that successfully showed there are simple actions PCPs can take, such as revising their after-hours telephone script, ensuring a written triage policy for urgent visits that all staff follow and ensuring patients are aware of ways to access PCP advice after-hours. In GDAHC’s pilot, PCP practices reduced their patients' use of EDs for PCP treatable conditions from a high of 49.2 visits/1000 to just 7.3 visits/1000 at the end of the four-month project. In addition to PCP actions, GDAHC has a campaign to educate consumers about appropriate settings of care; GDAHC created a Stoplight poster, brochure and presentation that can be used to educate consumers. GDAHC printed 5,000 Stoplight posters of various sizes and is in the process of distributing them throughout the region to be displayed in physician practices, employee lunchrooms and other settings throughout the community so consumers get a consistent and repeated message. More information and details about the PCP pilot are available at www.gdahc.org.
Previous
Next

Using Measurement to Improve Performance

It is important to recognize that Regional Health Improvement Collaboratives are not only collecting and publicly reporting an extensive array of quality measures, they are also actively using those measures with providers to encourage improvements in the quality of healthcare in their communities. In many cases, the measures have been developed specifically to support a local quality improvement initiative, rather than the other way around. For example:

Although measurement, reporting and changes in payment systems are necessary to support higher-value healthcare delivery, improvements in quality, efficiency, and patient satisfaction are actually achieved through the actions of front-line healthcare workers. Regional Health Improvement Collaboratives operate programs designed to improve the way that physicians, nurses, hospital administrators, and other healthcare professionals deliver care, ranging from identifying and disseminating best practices in care delivery, to providing affordable training, coaching, and technical assistance to practitioners on ways to analyze problems in care delivery and ways to design and successfully implement solutions, to helping healthcare providers reorganize and modernize their operations to support better-quality, more-affordable care.

The Center for Medicare and Medicaid Services (CMS) Innovation Center launched a nationwide public-private collaboration called the Hospital Engagement Networks (HEN) to identify and create innovative solutions designed to reduce patient harm and improve care coordination. CMS awarded 26 organizations a two-year contract to help identify the key improvements and spread initiatives across their defined population.  The Iowa Healthcare Collaborative was awarded the sole Iowa-based contract to serve Iowa hospitals in this campaign. The 127 hospitals participating in the Iowa-based Hospital Engagement Network (HEN) prevented potential harm to more than 4,300 patients in 2013 and reduced health care costs by more than $51 million, according to data released by the Iowa Healthcare Collaborative (IHC), which administers the network. 

Learn more: