TOOLS FOR MEASURING QUALITY NURS 8302

Walden University TOOLS FOR MEASURING QUALITY NURS 8302-Step-By-Step Guide

This guide will demonstrate how to complete the Walden University TOOLS FOR MEASURING QUALITY NURS 8302 assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.

How to Research and Prepare for TOOLS FOR MEASURING QUALITY NURS 8302                       

Whether one passes or fails an academic assignment such as the Walden University TOOLS FOR MEASURING QUALITY NURS 8302 depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

How to Write the Introduction for TOOLS FOR MEASURING QUALITY NURS 8302                       

The introduction for the Walden University TOOLS FOR MEASURING QUALITY NURS 8302 is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

How to Write the Body for TOOLS FOR MEASURING QUALITY NURS 8302                       

After the introduction, move into the main part of the TOOLS FOR MEASURING QUALITY NURS 8302  assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

How to Write the Conclusion for TOOLS FOR MEASURING QUALITY NURS 8302                       

After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

How to Format the References List for TOOLS FOR MEASURING QUALITY NURS 8302                       

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

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TOOLS FOR MEASURING QUALITY NURS 8302

TOOLS FOR MEASURING QUALITY NURS 8302

In health care, quality measurement is defined as the practice of using data to assess health plans and performance of health care professionals based on accepted standards of quality. Quality measures are tools that assist in gauging and quantifying healthcare practices, outcomes, organizational structures, patients’ viewpoints, and systems that are attributed to the potential of delivering quality health care. The ultimate goals of quality measures include provision of quality, effective, efficient, safe, equitable, timely, and patient-centered care (CMS, 2019). Essentially, quality measures are multifaceted and monitor care across the entire health care organization. Measuring quality in health care is a crucial component of health care quality enhancement process. Often, the quality of care in America is marred by considerable imperfections. Studies indicate that there is significant underutilization, overutilization, and misuse of care services. Besides, provision of health care is disjointed, disorganized, and intricate; hence, exposing patients to the risk of severe harm or even death.

            In turn, quality measurement act as a critical tool for enhancing health care delivery by ensuring that challenges such as underutilization, overutilization, and misuse of health care services are avoided. As a result, quality measurement helps in improving patient safety, increasing accountability of health insurance plan and health care professionals for delivery of quality care, recognizing what works best or what does not foster health care improvement, guiding health care consumers in making informed decisions on their health care, and determining and addressing health care disparities and outcomes.

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            Quality measures are categorized into three types including structure, outcomes, and process measures that are established to evaluate and contrast health care quality in organizations. Consequently, this paper seeks to delve into these three measures by exploring different aspects of these measures such as their definition, numerical depiction, techniques of data gathering, how both compare externally to the same settings, whether or not every measure is risk adjusted, and the kind of objectives health care settings may set based on each measure. Moreover, the paper will also highlight the essence of all the three measures to the health care organization. The paper will also strive to associate the three measures with patient safety, the cost accumulated from poor quality, and the general health care cost.

Structure Measures

            Fundamentally, structural measures are crucial in providing the consumers with a picture of the health care provider’s capacity, processes, and systems to foster quality care (Kessell et al., 2015). For instance, the measures will depict a number of factors such as the ratio of physicians to patients, the number of certified physicians, and whether the health care setting uses healthcare informatics such as electronic health records or medication order entry systems. Based on this backdrop, structure measures can, therefore, be defined as methods of assessing the health care organization’s infrastructure. The infrastructure may encompass the hospitals or physician offices, and if such settings have the capacity to provide patient care (AHRQ, 2019).  Moreover, structure measures also encompass factors such as the policy situations in the facilities that provide care, staffing of facilities and workforce proficiency, and accessibility of resources with the health care setting. Overall, structural measures aim at evaluating the features of health care organization in relation to several aspects such as workforce, policies, and facilities that help in health care delivery (AHRQ, 2019).   The structure measures are critical to the health care consumers in making informed decision on the choice of the facility to seek care because they portray the capability, systems, and processes of the care providers to deliver quality care. In many instances, structural measures are utilized in certification or endorsement programs that establish the mi minimal prerequisites for health care settings. As such, structure measures may be resourceful in providing blue print for the health organizations to follow in situations where the organization assumes responsibility for fresh activities or new populations.

            Organizations such as Leapfrog group, which is tasked with responsibility of designing and sustaining a measure set intended for health facility quality and safety practices designed one of such measures. Besides, the quality indicators (QIs) developed by the Agency for Healthcare Research and Quality (AHRQ) are increasingly being used by many report card sponsors to determine structure measures. Principally, structure quality measures are categorized into four areas of measurement including prevention, patient safety indicators (PSIs), inpatient quality indicators (IQIs), and pediatric quality indicators (PedQIs).  The structure quality measures are construed as ratios. In this construction, the numerators cases may or may not be accommodated within the denominator, and the denominator is regarded as the most appropriate substitute available for the existing population at risk. This situation is attributed to the fact that the population cannot be enumerated (AHRQ, 2019b). Notably, the quality measures were originally designed for numerous objectives such as pay-for-performance initiatives, enhancement of health care quality, and assessment of public health. Regarding the sources of data in this quality measurement, several sources are available including national associations, health care organizations, or state agencies. Besides, data can also be sourced from administrative data for AHRQ’s QIs measures (AHRQ, 2019b).  

            Primarily, the IQs and PSIs developed by AHRQ characterize health outcomes. Therefore, they are susceptible to the morbidity lumber of the patient population. As such, they should be risk adjusted to enable convincing quality comparisons. The measures apply the All Patient Refined Diagnosis-Related Groups (APR- DRGs), which is a system developed by 3M Health Information Systems (3M, 2016). The APR- DRGs refers to a risk modification system that considers every patient irrespective of whether or not they are insured under the Medicare. This risk modification system operates on the basis of two standards including the categorization of high rigorousness of the disease and mortality risk by various illnesses and succeeding interface of such illnesses. However, the risk of mortality and gravity of the disease rely on the primary conditions of the patient (3M, 2016).

            While determining the structural quality measures, it is imperative for the health care settings to create goals and work towards attaining a specific percentage of customer satisfaction. For example, the intensive care unit (ICU) may set a goal of ensuring 80% patients satisfaction in managing pain during the hospitalization. This goal may be distinguished further by personal patient satisfaction indicators, and consequently an average is deliberated to provide the entire satisfaction score for the health care organization. Determination of percentage of customer satisfaction is essential to the health care facility because it enables the organization to assess the areas of their strengths and weakness areas that requires improvement. Essentially, the present society is characterized by significant patient acuity in modern medicine and the health care consumers are increasingly gaining insights of the health care industry and their involvedness in determining the care they want. Therefore, in an effort to deliver patient-centered care, health care organizations should be in a position to demonstrate the effectiveness of the care they provide.   Regarding the comparison with other facilities, it is appropriate to hold outpatient facilities to a distinct array of standards depending on the level of care such outpatient facilities provide. For example, the patients should be worried about the time they spend on waiting to see physicians, but they should not be worried by the quality of the food since food is not part of the services offered.

Outcome Measures

            Outcome measures work by monitoring health of the patients based on the care they received. That is, outcomes measures considers both deliberate and accidental effects that care create on patients’ health, functionality, and health status. The outcome quality measures also evaluate whether or not the objectives of the care are attained (Wiering, de Boer & Delnoij, 2017). Essentially, outcome measures forms the epic of quality measurement in health care. Fundamentally, the crucial aim of patients is to survive the sickness and have their health status improved but not the organizational process that supports these outcomes. Outcome measures often encompass conventional measures of survival (mortality), prevalence of disease (morbidity), and concerns of quality of life associated with health. Although these measures mostly integrate reported information concerning the level of patient satisfaction with care delivery services provided to them, these measures cannot fully ascertain the entire patient experience. Despite the importance of the outcome measures to patients and care providers, their essence is challenged on the ground of problematic establishment of a truly meaningful measures.  Besides, it is difficult to collect sufficient information to provide meaningful data concerning a specific outcome.

            As indicated above, outcome measures basically pinpoint the influence of the health care intervention or services on the patients’ health status. Often, an outcome connotes the results that emanate directly from array of factors, with some being beyond the power of the providers. Essentially, many tools can be used to assess the outcome measurement including the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospital Survey also known as the Hospital CAHPS or HCAHPS. The HCAHPS refers to a consistent survey tool and data gathering technique for determining the opinions of the patients regarding their care during their stay in the hospital. The HCAHPS was designed by the Centers for Medicare & Medicaid Services (CMS) and the Federal Agency for Healthcare Research and Quality (AHRQ) to deal with crucial sides that patients experience during the hospital stay such as receptiveness of the facility’s workforce, pain control, communication with clinicians, discharge information, medication communication care changeovers, hygiene and quietness of the hospital. The construction of this technique involves use of percentages and proportions method that encompasses use numerous performance ranging between 0% and 100%. This method enables several measures to be effortlessly averaged to facilitate generation of amalgamated measures and also to foster contrasting of performance in different measures ad sites. The method is straightforward and so, it is practical for the health care providers and also comprehensible to the health care consumers. For instance, contends that most of the survey questions captured in HCAHPS concerning experiences with patient care have been altered from their initial version such as “how often did your primary care doctor…” to a dichotomous interpretation such as “always”/”usually/never” compared to other responses. As a result, it is now possible to convey the responses in percentile quantity of patients having finest or near finest experiences (AHRQ, 2019b)

            The data from HCAHPS can be acquired directly from the hospital or through visiting the Hospital Compare Website. Mostly, the assembled data is kept by the hospital and forwarded to the federal government. On their side, the CMS tend to apply risk modification when considering the variations in the risk factors at the level of the beneficiary that impact the outcomes of the quality or the costs of the medical intervention irrespective of the kind of care given (Wasfy et al., 2017). Essentially, the risk adjustment utilized by the CMS entails approximation of the anticipated Medicare Taxpayer Identification Number’s (TIN’s) behaviors on quality measures or their projected Medicare tolerable expenses for cost measures, against the clinical intricacies of their recipients. In turn, this approximation is weighed against their real performance, and subsequently multiplied by the countrywide average to facilitate generation of a substantial score of measure.

            In the process of deliberating outcome measures in the intensive care unit (ICU) setting of the facility, it is important to set goals for the health care facilities to assist in enhancing the communication, coordination of care provision efforts, and to help in establishing effective team work with health care providers and patients concerning the post-discharge planning. These goals are critical to the ICU settings since readmission of patients shortly after discharge could attract some penalties such as the risk of subjecting the hospital to possible reduction of paid benefits associated with the care of patient during readmission care by CMS through the Affordable Care Act (Wasfy et al., 2017). Therefore, to avoid costly incidences of paying individually for the care of patients after being readmitted, it is advisable to for the health care organizations to strive for flawless discharge and transition. On the other hand, other care settings including outpatient clinic do not have the concerns about benefit reduction since the patients visiting such settings often present with minor diseases and they tend to have significantly reduced association with health care providers before being discharged. However, they are exposed to the public while in the process of recovering from the sickness, making them susceptible to attract other diseases that may prompt the patients to return back to the hospital. Therefore, in the ICU settings, the clinicians are required to most of these exposures while delivering more comprehensive treatment and sufficiently preparing the patients for discharge.

Process Measures

            Process measures are characterized by of the level in which health care providers go to provide health care to patients based on best care guidelines. In other words, process measures imply identification of particular actions taken by the health care providers to uphold and enhance health (AHRQ, 2019). Mostly, the process measures are associated with established treatments or processes that have been proven to optimize status of health or safeguard from future barriers or health conditions. Usually, process measures tend to depict the universally accepted outcomes emanating from the health care provided. Most importantly, the measures tend to assess the impacts, deliberate or involuntary, that care provided cause on the health, health status, and function of the patients. The measures are crucial because they provide a succinct, practical view to the providers which facilitate uncomplicated blue print of enhancing the performance. Moreover, the measures also explores whether or not the projected objectives of patient care are attained. In clinical practice, the Joint Commission’s ORYX is one of the types of process quality measure. Fundamentally, ORYX refers to an array of performance measurement necessities that are applied to monitor and endorse health care settings and programs (Heuer, Rankin, Reyes & Dihigo, 2019).  Like outcomes measurement, this quality measure is equally constructed through establishment of proportions and percentages. The information about ORYX measures can be sourced from the Quality Check section of the public quality report of the joint Commission. The users can access the performance of their preferred organization online or download the information freely. The data include particular facility’s scores and federal and state comparative data.

            Notably, the ORYX entails a risk adjusted measure and so, it is appropriate for the its dealers to make necessary data preparations for risk modification through locating the measure population to apply the risk adjustment. Moreover, it is highly advisable that the twofold risk factors should be recognized and noted down to show the existence or otherwise of a risk factor. Nonetheless, owing to incessant risk factors, it is important to use the definite value with the adjustments. However, in situations where the needed risk factors such as age, source of admission, or sex cannot be found either by missing or blank, there is need to allocate approximated value for every missing or blank risk factors. Consequently, Risk Models obtained from the Risk Model Information File issued by the Joint Commission is required to be used in the data to help in computing the anticipated values for every care occurrence in the measure population for risk modified measures. In turn, the values obtained forms the anticipated values that are conveyed to the Joint Commission for all contributing health care settings. Subsequently, all risk modified components of data for the measure in every health care setting is required to be computed and conveyed cumulatively to the Joint Commission as HCO-level data file.

            On the other hand, while taking process measures and goal setting for ICU settings into account, it is important to set goals to help in the health care setting take necessary actions to evade the development of relapse in patients. Process measures are crucial in helping the performance of internal audits and help the organizations to enhance their patient related process during patient care. These quality measures are mostly anchored on evidence-based practices which are used by the health care organizations to implement the necessary valuable interventions.  On the other side, in consideration of how the process measures can be used in an outpatient clinic as weighed against ICU setting, it is appropriate to consider the intensity of care offered by each facility. Understandably, each facility is expected to poses distinct processes and procedures for specific kinds of care. However, it is reasonable to believe that ICU setting ideally needs a more comprehensive care than outpatient clinic owing to the seriousness of the diseases presented in ICUs. Besides, ICUs generally undertake several activities such as therapies, lab tests, and diagnostics tests compared to outpatient clinic, as such, ICUs needs significantly more and thorough supervision to realize patients’ safety.

Conclusion

            It has been established in the paper that all the three quality measures have critical roles to play in the improvement of the patient safety. In particular, the structural measures have been shown to help the patients in making informed resolve about the safety levels and standards of the health care organizations prior to making a decision of whether or not to use the facility to provide their care. On the other hand, process measures are important to the facilities because they provide a platform for the facilities to assess themselves and advance their processes in the areas of weakness to realize patient safety. On their side, outcome measures stresses on accountability in the facilities to enhance patient safety, with government stepping in to restore confidence to patients and their close relatives. Contrastingly, the costs associated with poor quality in each of the three measures are massive. To begin with, wanting structural measures is risky to the organization as it leads to loss of confidence by the patients, thus, looking for the care in other facilities and eventually causing dire impacts to the bottom line of the facility. Likewise, poor process measures leads to a situation where the facility provide incoherent care. Besides, the staff becomes reluctant leading to fears of patient safety. On their side, the poor outcomes measures attracts punitive consequences for the facilities for failing to attain the thresholds of safe and quality patient health care. Taken together, failing to achieve these quality measures can result to dire repercussions such as increased cost of care emanating from deteriorating patient health  which in turn, prolongs hospital stays, leads to shortage of workforce, medical errors, lost of financial income.

References

Centers for Medicare & Medicaid Services (CMS). (2019). Quality Measures. Retrieved 27 September 2019, from https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures/index.html

Kessell, E., Pegany, V., Keolanui, B., Fulton, B. D., Scheffler, R. M., & Shortell, S. M. (2015). Review of medicare, medicaid, and commercial quality of care measures: considerations for assessing accountable care organizations. Journal of Health Politics, Policy and Law, 40(4), 761-796.

Agency for Healthcare Research & Quality (AHRQ). (2019)Types of Health Care Quality Measures . Retrieved 29 September 2019, from https://www.ahrq.gov/talkingquality/measures/types.html

 Agency for Healthcare Research & Quality (AHRQ). (2019). Part II. Introduction to Measures of Quality. Retrieved 29 September 2019, from http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/perfmeasguide/perfmeaspt2.html

Wiering, B., de Boer, D., & Delnoij, D. (2017). Patient involvement in the development of patient‐reported outcome measures: a scoping review. Health Expectations, 20(1), 11-23.

3M. (2016) 3M All Patient Refined Diagnosis Related Groups (APR DRGs). Retrieved from:https://www.forwardhealth.wi.gov/kw/pdf/handouts/3M_APR_DRG_Presentation.pdf

Wasfy, J. H., Zigler, C. M., Choirat, C., Wang, Y., Dominici, F., & Yeh, R. W. (2017). Readmission rates after passage of the hospital readmissions reduction program: a pre–post analysis. Annals of internal medicine, 166(5), 324-331.

How do we determine quality? Quality in other areas of our lives can be subjective, so as it relates to our nursing practice, how do we specifically ensure that quality is clearly defined and measurable?

Tools for measuring quality are used to assess the value measured, collected, or compared. These tools allow for subjectivity to be replaced with objectivity through data, formula, ranking, and analysis.

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For this Assignment, you will explore at least three rate-based measures of quality. You will deconstruct each measure to explore your understanding of the it, including its importance and its impact on patient safety, the cost of healthcare, and the overall quality of healthcare.

To Prepare:

• Review the Learning Resources for this week, and reflect on tools for measuring quality in nursing practice.
• Select three rate-based measurements of quality that you would like to focus on for this Assignment.
  • Note: These measurements must relate to some aspect of clinical or service quality that directly relates to patient care or the patient’s experience of care, and for the purposes of this Assignment, an analysis of staffing levels is not permitted. 
  • You can find useful information on quality indicators that are of interest to you on these websites and resources. You may choose only one of the three measures to be some form of patient satisfaction measure.
• Consider how the three rate-based measures (you will select) are defined, how the rates were determined or calculated, how the measures were collected, and how these measures are communicated to both internal and external stakeholders.
• Reflect on how the three rate-based measures (you will select) may relate to organizational goals for improved performance.
• Reflect on the three rate-based measures (you will select), and consider the importance of these measures on patient safety, cost of healthcare, and overall quality of healthcare.

The Assignment: (8–10 pages)

• Describe the three rate-based measures of quality you selected, and explain why.
• Deconstruct each measure to include the following:
  • Describe the definition of the measure.
  • Explain the numerical description of how the measure is constructed (the numerator/denominator measure counts, the formula used to construct the rate, etc.).
  • Explain how the data for this measure are collected.
  • Describe how the measurement is compared externally to other like settings, and differentiate between the actual rate and a percentile ranking. Be specific.
  • Explain whether the measure is risk adjusted or not. If so, explain briefly how this is accomplished.
  • Describe how goals might be set for each measure in an aggressive organization, which is seeking to excel in the marketplace. Be specific and provide examples.
• Describe the importance of each measure to a chosen clinical organization and setting.
  • Using the websites and resources you can choose a hospital, a nursing home, a home health agency, a dialysis center, a health plan, an outpatient clinic, or private office. A total population of patient types is also acceptable, but please be specific as to the setting. That is, if you are interested in patients with chronic illness across the continuum of care, you might home in a particular health plan, a multispecialty practice setting or a healthcare organization with both inpatient and outpatient/clinic settings. 
  • Note: Faculty appointments and academic settings are not permitted for this exercise. For all other settings, consult the Instructor for guidance. You do not need actual data from a given organization to complete this Assignment. 
• Explain how each measure you selected relates to patient safety, to the cost of poor quality, and to the overall cost of healthcare delivery. Be specific and provide examples.

By Day 7

There is nothing to submit this week. This Assignment is due by Day 7 of Week 4.

Irrespective of their health conditions, all patients require timely, effective, and quality health care services. Overall, achieving the desired state of health care quality remains a leading goal of health care organizations. Processes, procedures, and routine interactions should ensure that patients are excellently served. Satisfaction should be a guiding principle. In health practice, quality of care represents the degree to which health services meet the desired outcomes. To examine whether they are providing quality care, organizations should regularly evaluate their performance using rate-based quality measures. Evaluating performance guided by rate-based quality measures is a practical way of improving care delivery and patient outcomes. This paper describes rate-based measures of quality in health care organizations. It further deconstructs each measure, describes the importance, and explains how each measure relates to patient safety and the cost of healthcare delivery.

Rate-Based Measures: Description

Quality measures are reliable indicators of a healthcare organization’s capacity to deliver optimal care. Rates show the difference between performance and expectations. Appropriate rate-based quality measures for in-depth exploration include readmission rates, complication rates, and post-procedure death rates. These measures have been selected since they directly relate to the type of care that patients receive in health care settings. Their rates are inversely proportional to the quality of care. For instance, high readmission rates indicate that the quality of care does not meet the desired performance levels. The same case applies to complication rates and post-procedure death rates.

The other reason for selecting these measures is their significance in the overall health care provision in the United States. The Centers for Medicare & Medicaid Services (CMS) reports that quality health care is a priority for the President of the United States, Department of Health and Human Services, and CMS (Centers for Medicare & Medicaid, 2020). Due to the significance and interest of quality health care, CMS uses quality initiatives for health improvement in many instances and spends considerable resources in quality enhancement programs. As a result, the rate-based quality measures indicate the extent to which health care organizations align with the President’s and CMS’ expectations as far as quality is concerned.

Health care organizations require tools for quantifying healthcare processes. The selected rate-based measures are used for quantifying outcomes. Quantifying the processes and outcomes shows an organization’s ability to provide high-quality care. Quantifying outcomes by rating them also indicates the areas requiring more attention as the organization adopts new quality improvement mechanisms.

Deconstructing Each Measure

When a patient visits a healthcare organization for medical assistance, the general desire is to get an accurate diagnosis and proper treatment. Such assistance promotes healing and helps the patient to recover within the healthcare facility or at home. Unfortunately, health complications may necessitate readmission. Upadhyay et al. (2019) described readmission rate as hospital admission occurring within a specified time frame after discharge from the first admission. As a result, the readmission rate denotes the percentage of patients readmitted after discharge. Readmission rates may be calculated in terms of weeks, months, or annual readmission.

With hospital-acquired infections (HAIs) a sincere concern in health care delivery, the complication rate should guide health care providers in preventing HAIs. Lim (2019) described the complication rate as the percentage of patients developing complications resulting from care. In most instances, complication rates are high in complex procedures such as surgeries. For instance, the complication rate associated with heart surgeries is often higher than treatment for malaria. Routinely, many health care organizations track the complication rate by a specific timeframe or division. In this case, all complications can be calculated together or segmented according to the type of disease. The extent of complication rate indicates the quality of care that patients receive in a particular health care setting.

After the treatment, patients always look forward to a full and speedy recovery. Healthcare organizations also implement the necessary measures to prevent deaths to ensure that the mortality rates for all illnesses are as low as possible. Despite these efforts, deaths still occur after procedures. According to Lim (2019), the post-procedure death rate is the number of deaths occurring after treatment. The death rate usually varies depending on the procedure. Like readmissions and complication rates, a high post-procedure death rate may be an indicator of low-quality health services.

To construct the readmission rate, the number of readmitted patients (numerator) is divided by the number of patients served during a given period (denominator). The figure is given in percentage. For instance, if five patients were readmitted after 200 discharges, the readmission rate would be (5/200) x 100, giving 2.5%.  The complication rate is constructed by dividing the number of patients who develop complications by the number who received care in a given timeframe. The post-procedure death rate is calculated by dividing the number of deaths by the number of patients who received treatment. The post-procedure death rate is provided for each procedure. Like complication rates, post-procedure death rates differ depending on the type of procedure.

In each case, comparative data analysis occurs to develop the measure and get the necessary meaning to guide decision-making. For readmission rates, health care organizations may opt to record readmission cases for all illnesses after discharge. Alternatively, they may collect data for specific illnesses, which helps to determine illnesses associated with the highest readmission rates. The same approach can be used for collecting data for complication rates. Data may be case-specific or combine all complications over a given timeframe.  Post-procedure death rates’ data can be tracked hospital-wide or for specific divisions and health care teams.

To determine whether a healthcare organization’s performance is within the expected performance levels, data comparison is necessary. According to the Centers for Medicare & Medicaid Services (2020), quality measures should be publicly reported. As a result, health care organizations make their data public when required, implying that their performance is visible to other settings in the same state or different regions. Shah et al. (2019) noted that the availability of such performance data, including readmission rates, allows the Readmissions Reduction Program (HRRP) to incentivize decreased readmissions. A healthcare organization can do comparative performance analysis to reflect on its performance versus other organizations through the publicly reported data.

The rates can be provided as actual figures or percentile ranking. Like illustrated in readmission, complication, and post-procedure death rate calculations, actual rates represent the figures of each measure calculated using historical operating functions and adjustment factors. For instance, the actual readmission rate is the number of readmissions divided by the number of discharges in a given time. Mostly, actual rates are given in percentage. On the other hand, percentile ranking is the percentage of scores in the frequency distribution equal or lower than the score. For instance, if the readmission rate is 65% of a hospital, 65 is the percentile rank. Since readmissions illustrate poor performance, the facility would have performed worse than 65% of other facilities included in the frequency distribution.

Some measures of quality are usually risk-adjusted. For accurate calculations of post-procedure death rate, the measurement must factor the risk level into calculations (Ng-Kamstra et al., 2018). The risk level varies for each procedure. Risk adjustment also applies to complication and readmission rates. Risk adjustment includes risk factors associated with a measure score, allowing fair and accurate healthcare outcomes comparison. A typical risk factor is the health status of a patient.

Healthcare organizations set different goals based on their missions, visions, and performance objectives. For an aggressive organization seeking to excel in the marketplace, a reasonable goal for readmission rate as a measure of quality is to reduce the rates to below the state and nationally minimum allowable levels. As a result, the organization would adopt the necessary measures to reduce the rates, such as bedside patient education and technology adoption in healthcare processes for better communication and patient monitoring.  For complication rate, an aggressive organization would set quality improvement goals focusing on reducing the complication rate. As a result, the organization would initiate measures to prevent complications after a medical procedure. Similar goals apply to the post-procedure death rate. The organization should be motivated to have no death case after a medical procedure. The reference point should always be the state and national performance benchmarks.

Importance of Each Rate-Based Measure to a Chosen Clinical Organization and Setting

All healthcare organizations have a moral and legal obligation to promote healthy living in the populace. Besides the usual diagnosis and treatment of illnesses, it is crucial to build lasting patient-provider relationships and adopt mechanisms for enhancing the quality, safety, and timeliness of care. Saint Joseph Hospital, Denver, is among clinical organizations providing primary and specialized care. In primary care, Saint Joseph Hospital’s fundamental principle is that the organization’s primary care providers are the first people that patients visit for their health questions and concerns (SLC Health Saint Joseph, 2021). Advanced care in Saint Joseph Hospital includes heart and vascular care, orthopedics, and emergency.

As a rate-based measure, the readmission rate is crucial at Saint Joseph Hospital as an indicator of the quality of care that patients receive. Gupta et al. (2019) described hospital readmission within 30 days as a significant quality measure since it represents a potentially preventable adverse outcome. With Saint Joseph Hospital engaging in complex procedures such as heart surgery, cardiac rehabilitation, and heart arrhythmia treatment, the chances of readmissions might be high in such settings. Brunner-La Rocca et al. (2020) observed that the readmission rate is high in advanced care such as cardiovascular health procedures. As a result, Saint Joseph’s management should use the readmission rate as a motivation to improve quality outcomes. The rates indicate the magnitude of effort required to achieve the desired level of patient satisfaction.

Like other clinical settings, Saint Joseph Hospital should apply evidence-based practice strategies to improve clinical outcomes. Its primary, emergency and acute care outcomes should match the required performance benchmarks at local, state, and national levels. Achieving this critical goal requires Saint Joseph Hospital to collect data and measure performance on significant outcome areas. Accordingly, complication rates indicate areas that need more intervention as far as the quality of care is concerned. For instance, shock, hemorrhage, urinary retention, and pulmonary embolism are common complications after surgeries. Since they are costly to manage and extend hospital stays, measuring their rates is crucial always. The rate indicates the extent and type of responses required to ensure that Saint Joseph Hospital provides care that meets all the quality standards.

As a measure of care quality, the post-procedure death rate is also crucial to Saint Joseph’s Hospital in decision making and resource allocation. From a general operation viewpoint, healthcare organizations must reduce mortality rates as low as possible. The goal should be conducting procedures associated with zero deaths. Like in readmission and complication rates, post-procedure death rates indicate the areas of attention requiring improvement to reduce mortality rates. For instance, deaths associated with health complications can be prevented by increasing or improving interventions that reduce complications. Deaths associated with home-based care after surgeries can be prevented by improving home-based care.

Relationship with Patient Safety, Cost of Poor Quality, and the Overall Cost of Healthcare Delivery

It is an unfortunate scenario for patients to receive unsatisfactory care. According to Upadhyay et al. (2019), readmissions indicate unsafe transitions between points of care (hospital to home). As a result, readmission rates indicate the extent to which the patient received care that guarantees safety. As an indicator of low-quality services, readmission rates show that the patient receives care in unsafe settings. Health complications, emotional and financial burdens associated with increased readmissions are costly to manage. Patients are forced to travel more to get care, involve family members, and utilize more resources. The entire process is costly and increases the illness burden. Regarding the overall cost of care, the annual cost of readmissions to the US healthcare system is as high as $17.4 billion annually (Warcho et al., 2019). Such resources could be used for illness prevention and promotion programs if there were no readmissions.

Complications have similarly profound effects on safety concerns and cost implications. Health complications risk patient safety due to extended hospital stays and frequent visits. Health complications also increase the mortality rate. Postoperative complications, including atelectasis, wound infection, and deep vein thrombosis, are costly to treat and manage. In a review of postoperative complications cost of 6,387 patients, prolonged ventilation management was found to consume approximately $48,168 and renal failure $18,528 (Merkow et al., 2020). Such costs can be minimized by a proportional reduction in complication rates.

The post-procedure death rate not only indicates patient safety concerns but is a threat to their lives. Unlike readmissions and complications, death rates show a health care facility’s incapacity to guarantee patient safety. Deaths are costly since the patient and the family does not get the value for their money. Hospitals also incur huge costs associated with litigation if the family is not satisfied with how the patient was handled.

In conclusion, rate-based quality measures indicate the extent to which a healthcare organization provides quality healthcare services. In this paper, readmission, complication, and post-procedure death rates have been discussed as rate-based quality measures.  The three measures were selected since they directly relate to the type of care that patients receive in healthcare settings. The case of Saint Joseph Hospital has been provided to illustrate the importance of each rate-based measure. In terms of safety, the magnitude of each rate is inversely proportional to patient safety. Poor quality care is costly to manage from a patient’s and healthcare delivery’s dimensions. As a result, healthcare organizations should heavily invest in strategies that reduce readmissions, complications, and post-procedure rates to acceptable levels.

References

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