Episode-Based Approaches to Measuring Health Care Quality

Published in: Medical Care Research and Review, 2016

Posted on RAND.org on February 29, 2016

by Peter S. Hussey, Mark W. Friedberg, Rebecca Anhang Price, Susan L. Lovejoy, Cheryl L. Damberg

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Research Questions

  1. Would reframing health care quality measurement on the basis of an episode of care—from diagnosis to treatment and follow up—provide a more comprehensive view of care quality?
  2. What quality measures would need to be developed in order to implement this framework?
  3. What challenges would need to be addressed?

Most currently available quality measures reflect point-in-time provider tasks, providing a limited and fragmented assessment of care. The concept of episodes of care could be used to develop quality measurement approaches that reflect longer periods of care. With input from clinical experts, we constructed episode-of-care frameworks for six illustrative conditions and identified potential gaps and measure development priority areas. Episode-based measures could assess changes in health outcomes ("delta measures"), the amount of time during an episode in which a patient has suboptimal health status ("integral measures"), quality contingent upon events occurring previously ("contingent measures"), and composites of measures throughout the episode. This article identifies a number of challenges that will need to be addressed to advance operationalization of episode-based quality measurement.

Key Findings

  • Although complex, episode-based quality measurement would provide a more complete picture of care quality than current approaches.
  • Researchers created five categories of quality measures to assess an episode of care: outcome, delta, integral, contingent, and composite.
  • Available measures could still be used, but new quality measures would need to be developed to address significant gaps within the five categories.
  • Challenges would involve developing consensus with providers and applying measures in real world clinical environments.
  • An incremental approach will be needed with substantial investment in quality measurement methods and tools, data capture, analytics, and process design.

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