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Top Clinical Quality Measures Impacted by Patient Engagement

Many of the most common clinical quality measures are inevitably shaped by patient engagement strategies, experts agree.

To understand the role of patient engagement in value-based care success, it is essential for healthcare leaders to understand the role patient engagement plays in clinical quality measures.

Clinical quality measures are tools used to examine the effectiveness and experience of patient care. Often employed in value-based care models, clinical quality measures seek to quantify the level of care a patient received. In a value-based care contract, meeting clinical quality measures usually results in shared savings for both the payer and the provider.

According to the Agency for Healthcare Research and Quality (AHRQ), clinical quality measures can be divided into three categories:

  • Structural measures
  • Process measures
  • Outcomes measures

Practicing strong patient engagement will play a big role in fulfilling some of the most common clinical quality measures. Understanding these measures, and how patient activation can shape them, will help healthcare organizations achieve their value-based care goals.

Structural measures

Structure measures assess a healthcare organization’s capacity and capability to deliver high-quality care. Although structural measures often relate to staffing, health IT systems that enable patient activation in care are pertinent.

Patient data access, patient portal access

One of the more prominent structural clinical quality measures is the presence of health IT such as the EHR. And in terms of patient engagement, this includes enabling patient data access and access to a patient portal.

The logic goes that a patient who can view her own medical records will be more informed about and more engaged in her care. That mindset fueled the patient data access provisions under meaningful use and ultimately prompted the Office of the National Coordinator for Health IT to include patient access to clinical notes in its final rule on information blocking.

In 2021, the ONC issued a report showing 97 percent of all hospitals and 99 percent of large hospitals offered patient portal access. And patient access to clinical notes is on the rise, too. Ahead of ONC’s enforcement of the information blocking rule, the industry saw a 10 percent increase in patient access to clinical notes, according to advocacy group OpenNotes.

Process measures

Process measures examine how healthcare organizations deliver healthcare, including the ways a provider might improve or maintain health. These measures largely include those related to clinical guidelines.

Patient safety

Patient safety measures include a set of clinical guidelines that, when adhered to, will ensure optimal patient results with no patient harm. Achieving good patient safety measures is essential to a good patient experience, most experts agree.

“Patient safety is fundamental to the promise we make to patients,” according to Gary Yates, MD, a strategic consulting partner at Press Ganey and patient safety expert. “We like to think of the patient experience as being the convergence of quality, safety, and the experience of care.”

In addition to adhering to clinical guidance, healthcare providers may consider partnering with patients to achieve patient safety. This can include patient teach back, asking patients to check that medical records are correct, and being honest and transparent with patients when a clinician has made a mistake.

Timeliness of care

Timeliness of care is not only a key measure of clinical quality—a patient could experience poor outcomes if she has to wait a long time to see a provider—but it also has a significant impact on the patient experience.

Most industry leaders measure timeliness of care by the proportion of adults or pediatric patients who were able to access care after the organization recognized a clinical need. According to AHRQ, failure to deliver that timely care could exacerbate medical conditions and result in poor clinical outcomes.

In as much as patient experience is concerned, long wait times can be a detriment. Patients have reported that sitting in the office waiting room for a while can impact their overall healthcare experience, as can waiting to actually obtain an appointment.

Adherence to clinical guidelines, preventive care

Under value-based care contracts, preventive services can ensure detection of an illness before it has escalated, allowing for more cost-effective care management.

A value-based care contract might ask about the percentage of covered people getting a preventive service like a mammogram. In the chronic care space, the contract might measure the proportion of people getting regular care management checks, like a patient with diabetes getting their blood sugar measured.

Healthcare providers need to practice strong patient engagement to achieve these clinical quality measures because they hinge on patients being activated in their care. Organizations should lean on their primary care provider staff to alert patients about preventive screenings. Using data analytics models, organizations can also sift through patient data to detect care gaps and employ patient outreach campaigns to compel engagement.

Outcomes measures

Outcomes measures look at the actual result of the care delivered and assess whether the care quality administered was successful.

Mortality rates

Mortality rates examine the death rate for a certain population during a certain period of time. Some clinical quality measures look at 30-day all-cause mortality, while some look at mortality due to surgical complications or certain disease states.

Regardless of domain, mortality seeks to assess the efficacy of the care delivered, patient safety, and adherence to clinical guidelines that may have staved off acute and life-threatening episodes.

Hospital readmissions

Like mortality rates, hospital readmissions can look at a specific population during a certain period of time. Most commonly, provider organizations are beholden to 30-day hospital readmission measures. In theory, a healthcare organization should avoid 30-day hospital readmissions if it delivered high-quality care and supported the patient through the post-acute discharge process.

Healthcare organizations can achieve lower 30-day hospital readmission rates if they provide strong patient education about recovery, engage family caregivers, and engage patients in follow-up care.

Patient experience, satisfaction scores

Perhaps most strongly correlated with patient engagement, most value-based care models measure patient experience and patient satisfaction, usually using the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. Some models and organizations use their own homegrown patient experience surveys, which in many cases draw from the CAHPS survey.

In recent years, healthcare experts have acknowledged that the retrospective analysis provided by a CAHPS survey is not always enough to support clinical quality improvement. Real-time patient satisfaction surveying, often supported by bedside tablets, give clinicians insights into the patient experience before the patient has left the clinic or hospital, giving them the chance to rectify a potentially negative situation.

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