Measurement of Quality of Health Services

Measurement of quality of health services is the process of using data to evaluate the performance of health services programmes and providers against recognized quality standards.

Quality of health services can be assessed at several levels, from the services provided by individual health professionals (e.g. nurses or physicians) and services provided by health systems as determined by national health plans.

It is worth noting that measuring quality of health services is a process requiring precise determination and specification of useful measures.

The science upon which measurement is based is constantly changing as best practices are adapted due to constant new evidence brought by scientific development.

Rationale for Measuring Quality

Measurement is critical to quality improvement initiatives because it separates what you think is happening from what is really happening, it can establish a baseline and show progress overtime, and can help to avoid implementing ineffective solutions

Measurement provides information about how the objective for improvement is being achieved. Comparing collected date on a particular process of care under assessment with standard requirements reveals the gap i.e. what should be improved. Measurements provide objective information that allows the development and testing of changes, as well as monitoring progress after a change has been implemented.

In health services provision, measurement is done in order to:

• Compare current practices to set standards or guidelines
• Identify performance gaps
• Identify opportunities for improvement
• Measure and monitor changes to ensure improvement is maintained over time
• Raise awareness of performance gaps among health service providers
• Identify client needs and levels of satisfaction
• Guide prioritisation of QI activities.

Importance of Measuring Quality

Without measurement it would be impossible to determine if any improvements took place. Measurement can provide relevant information related to quality health services, for example:

• A decrease from 70% to 5% in loss to follow-up rates among patients on ART
• A decrease in waiting time to see a health service provider from 4-5 hours to 30 minutes at each service point
• To increase availability of human resource for health from 44% to 90% in public health facilities.

Measurement is an important component of quality improvement because it helps to:

• Identify what is not working in the process of health service delivery
• Make decisions based on fact, not opinion
• Prevent overuse, underuse and misuse of health services
• Ensure client safety
• Hold health insurance and health service providers accountable for providing high quality health services

Types of Quality Measures of Health Services

Quality measures assess health services across the full continuum of service delivery, from the level of individual client all the way up to the level of health insurance plans. Hundreds of different quality measures are used in health services. These measures generally fall into four types:

• Structure
• Process
• Outcome
• Client experience

Structure

Structure denotes the attributes of the settings in which health services are provided. Structure can be divided into:

1. Inputs which include attributes of human resources (such as the number and qualifications of health workers) and material resources (such as facilities, infrastructures, computerized information system, equipment and financing) and
2. Organizational systems i.e. how resources are arranged and managed (such as administrative policies, decision-making hierarchy, reimbursement mechanisms, referral systems and medical/nursing staff organization)

Process

Measurement of process should examine specific activities that make up health service delivery and provide timely information about activities that might improve outcomes if changed. Monitoring process is important in order to identify solutions for improvement. Once a process that leads to better health outcomes is established, maintenance of a higher level of performance for that particular process is important in order to avoid poor outcomes.

Outcomes

Outcomes refer to the effects of health services on health status of patients and populations.

Outcomes can be:

• Intermediate markers of disease progression (such as clinical improvement among HIV patients receiving ARVs, increase in CD4 counts among HIV patients receiving ART:; or,
• End results of effects of health services (such as mortality, morbidity, functional status, quality of life and patient satisfaction).

Measuring outcomes enables us to monitor the status of patients’ health over time (e.g. an improvement in symptoms or morbidity or mortality).

Client Experience

Client experience measures provide feedback on clients’ experience with health services delivery. Measures may range from accessibility and clarity of information provided by health services providers to how quickly clients can get services when in need. Clients’ positive or negative experience relate to quality of health services provided.

Sources of data for measuring quality

Measuring quality requires specifically designed tools to measure the different aspects of service delivery. Once quality improvement interventions are prioritized, several data sources will be carefully selected to ensure appropriate and adequate data is collected.

Obtaining data for measuring quality can be difficult and expensive, and errors can occur at several levels. How one chooses appropriate source of data for quality measurement depends on the purpose for which the information will be used. No single source of data is sufficient to provide enough information for measuring quality.

In general, common sources of data for measuring quality include;

• Routine surveillance
• Review of records and databases (such as CTC  cards, ART and Pre-ART registers, CTC database, DHIS, Pharmacy module database etc)
• Surveys (e.g. clients’ opinion survey on quality of care provided, level of satisfaction etc)
• Direct observations e.g. provider/client interactions
• Interviews.

Clients’ records and database management are key components of measuring and improving the quality of health services provided to chronic conditions like HIV and AIDS.

KEYWORDS

• quality measures examples
• types of quality measures
• rate-based measures of quality
• process measure examples in healthcare
• healthcare quality measurement tools
• how to measure quality of care in hospitals

LINKS

• https://www.ncbi.nlm.nih.gov/books/NBK230815/#:~:text=Structural%20measures%20of%20quality%20typically,location%2C%20and%20accessibility%20of%20services.
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5418826/
• https://www.ahrq.gov/talkingquality/measures/types.html
• https://apps.who.int/iris/bitstream/handle/10665/260544/WHO-HIS-SDS-2018.1-eng.pdf
• https://www.emerald.com/insight/content/doi/10.1108/JHR-07-2019-0152/full/html
• https://www.researchgate.net/profile/Ghadeer_Dweik/post/How_do_I_measure_the_quality_of_health_care_in_hospitals/attachment/59d6221979197b807798072f/AS%3A299948944969737%401448524809832/download/HSI+Quality+Measurement_Brief_final_web.pdf
• https://www.ibm.com/topics/quality-measures-healthcare
• https://academic.oup.com/intqhc/article/31/3/183/5039910