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| The Vermont Health Care Quality Report 2008 |
Ch2: Measuring Quality of Care Ch3: Chronic Illness in Vermont
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Measuring the Quality of Care Using a Family of Scientific Indicators (click for printable PDF) Defining the Quality of healthcare in simple terms is difficult. For most consumers of care, quality is very contextual and influenced by our personal expectations and experiences. For the purposes of this report, which looks at quality from a statewide and regional level, VPQ uses scientifically sound measures that look at aggregated experience over time for a population of people who either live in one area of the state or received care at one of the state’s care facilities. In general quality measures typically employ one of three lens to view care: 1) missed opportunities or under-care; 2) excessive use of services or over-care; and 3) misuse or errors. One of the measurement strategies used in this report is that developed by the federal agency whose mission is to assist the country in advancing the science of quality measurement and quality improvement. The Agency for Healthcare Research and Quality (AHRQ) has developed a family of measures to identify apparent variations in the quality of inpatient and outpatient care. These Quality Indicators (QIs) are organized into four modules: Prevention Quality Indicators (PQIs), Inpatient Quality Indicators (IQIs), Patient Safety Indicators (PSIs), and Pediatric Quality Indicators (PDIs)[1] These indicators are rigorous, standardized measures with an assessment of the overall population and, where appropriate, regional and national comparisons. The AHRQ indicators use administrative hospital discharge data as a window into the medical care delivered in hospitals. These data, which are collected as a routine step in the delivery of hospital services, provide information on diagnoses, procedures, age, gender, admission source, and discharge status. Although administrative data alone cannot provide a complete assessment of quality, they can be used to identify potential quality problems or areas of excellence which can then be further investigated and studied, either to address needed improvements or to assist adaption of excellence at other facilities or in other communities. Prevention Quality Indicators (preventable hospitalizations) use inpatient care to identify “ambulatory care sensitive conditions”. These are conditions for which quality preventive care in an outpatient setting can potentially prevent the need for hospitalization and potentially avoidable complications. These indicators assess the quality of outpatient care and the prevention of complications. This set of measures focuses on the overall care accessible in a community rather than the quality of care delivered in the community hospital. These measures identify potential underuse of ambulatory care. Inpatient Quality Indicators provide a perspective on the quality of care in Vermont hospitals. These indicators can identify potential quality problems and the need for further investigation. The indicators can also identify local benchmarks of excellence. These measures identify principally quality issues of overuse or misuse. Patient Safety Indicators are measures that screen for potentially preventable complications and adverse events. These measures focus on principally misuse. Pediatric Quality Indicators are measures that focus on the quality of children’s healthcare as represented by the information that can be gleaned from the aggregated data set of all children hospitalized in the state. [1] The Agency of Healthcare Research and Quality. http://www.qualityindicators.ahrq.gov. |
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