Rate-Based Quality Indicators

Rate-Based Quality Indicators
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Rate-based Indicators
Health care professionals worldwide play vital roles, particularly because people’s lives are at stake. As such, they are mandated and obligated to provide and offer the best possible care and treatment without any forms of favoritism or discrimination. On the same breadth, health care facilities are supposed to ensure they employ qualified and skilled individuals and who will assist significantly to improve patient outcomes. It is based on the above facts that over the recent past, there have been considerable growing interests not only from researchers and policymakers but also the general public concerning the measurement of quality care, otherwise known as quality indicators in the medical sector. These parties are continuously seeking systematic modes of measuring and benchmarking the quality of care provided by different health care providers and facilities. Countries such as Australia, Italy, and Belgium have made it mandatory for the reporting of quality of care in the overall health performance reports. This growing interest in quality measurement and indicators is being fostered by rapid developments in both information technology and measurement methodologies. Quality indicators in health care are identified as quantitative measures that offer feedback on not just the effectiveness and safety but also people-centeredness of care provided by medical personnel. They are usually employed as a summative mechanism to cater for external accountability and verification. They also serve as a formative mechanism for quality improvement. While there are various ways of classifying quality indicators, one notable and most common option that will also form the focus of the research paper is rate-based indicators.
Overview of Clinical Quality Indicators
Over the recent past, the provision of quality service has proven to be a key factor in many industries and sectors, including health care. From a medical perspective, clinical quality indicators are quantitative measures used as guides. They assist in the monitoring and evaluation of the quality of fundamental patient care and the support service activities offered to them while receiving treatment. Mainz (2003) reiterates the above point and shares “quality indicators are screens or flags that identify or direct attention to specific performance issues within a health care organization that should be subject of more intense review”. The growing interest in quality measures and indicators stems from the advanced developments in information technology and methods of measuring. It is through quality indicators that policymakers and medical associations can undoubtedly assure the provision of high-quality care in their respective regions. This is because quality indicators provide them reliable information that assists them in identifying good and bad health care providers, practices, and facilities. Clinical quality indicators also assist in the comparison and contrast of the effectiveness of different forms of treatment and procedures (Ahrq.gov, 2020). There are two general types of quality indicators in health care. The first type includes the Sentinel event indicators that measure undesirable processes and outcomes such as maternal death. The second types of the indicator are the rate-based indicators. They are the most common form and are often expressed as proportions or rates with vivid numerators and denominators.
Rate-Based Indicators
As has been shared in the previous sections, rate-based indicators are the most common forms of measurement in the health care industry. They measure an event within patient care for which some rate and level of occurrence is acceptable and allowed. According to Atkinson et al. (2010), “ a rate-based indicator measures a patient care event that requires further assessment (individual case review) only if the rate of events shows a significant trend within an institution over time, exceeds predetermined thresholds or evidence significant difference when compared to that of peer institutions”. From the above statement, it can be construed that rate-based indicators are screens or rather flags from which any significant deviations from the norm warrant for more analysis and investigation. They, therefore, assist in not only measuring and reporting but also comparing health care outcomes in line with the quadruple aim of health care. To begin with, they assist in improving the patient experience of care. Secondly, they help to alleviate the health status of people globally. Thirdly, they also play crucial roles in the reduction of the per capita cost of medical treatment (Quentin et al., 2019). Lastly, rate-based indicators assist in reducing medical errors because of clinician and staff burnout. There are different types of rate-based measurements and indicators of quality, including the following.
Example 1: The Number of Unplanned Hospital Readmissions in John Hopkins Hospital, over two weeks after discharge.
An above example is a typical form of the rate-based indicators employed by health care facilities worldwide. It seeks to identify the number of patients who may get readmitted upon being discharged, say, two weeks. Effective health care facilities always thrive to ensure that they treat their patients fully to avoid them being falling ill from the same ailments. They ensure they task skilled and qualified professionals to oversee the treatment of patients and, in so doing, give assurance that utmost quality care will be provided (Tinker, 2018). Despite the exhaustive initiatives of hospitals and the medical providers, there are scenarios when patients relapse from the very conditions they were treated for and have to be readmitted. For instance, a diabetic patient may fail to take the prescribed medications as required resulting in complications. Nonetheless, the rate based indicator shared above is keen to ensure that hospitals and in this particular scenario, John Hopkins Hospital keep the rate of admissions very low. The low rate of admission is pegged to every 1000 patients admitted at the facility.
The above example can also be equated as follows with clear indications of the numerator and denominator.
Number of Unplanned Hospital Readmissions in John Hopkins Hospital over two weeks after discharge/ Total Number of Patients discharged from John Hopkins bi-weekly
The rate helps to ensure and foster patient safety because doctors and nurses will make it the mission to provide quality care. They will be keen to eliminate medical errors and any complications and conditions that the patient may pick up in the course of receiving treatment. A high rate of hospital readmissions against the total number of patients discharged during that period is a major cause of concern and warrants in-depth investigation from the medical associations the hospital’s leadership. For instance, let’s imagine that for every 200 people discharged bi-weekly, about 50 get readmitted for the same conditions. This number is quite high and represents ¼ of the hospital’s discharge. It could mean that the patients were either not treated satisfactorily or the medical personnel or not entirely equipped to provide quality care to patients at the facility. Similarly, high rates of readmissions are not only cost-ineffective to the patients but also the hospital. While the patient will have to pay for additional tests and medications, the hospital incurs costs by paying doctors and nurses who would have otherwise been attending to other patients. Reports indicate that the current cost of hospital readmission is in excess of $26 billion. This, coupled with the heavy penalties charged by the Centers for Medicare and Medicaid Services (CMS), is quite a burden for health care facilities such as John Hopkins Hospital.
The collection of the data for the above example has been made easy through advancements in information technology. With the development and implementation of electronic medical records in different health care facilities in the US, the examination of the number of patients who were discharged and then readmitted can be accessed at the click of a button. It is, however, essential to note that the rate-based indicator shared above is risk-adjusted. It takes into account the break out of certain diseases during the specified period. For instance, with the coronavirus pandemic and the risk of patients getting re-infected after testing negative and getting released from the hospital, it is vital to adjust the indicator.
Nonetheless, the above indicator offers a...