Table 1

Illustrative, parsimonious set of quality, outcome and cost measures*

Measure nameIOM quality dimensionTriple aim domainOutpatient focusInpatient focusPopulation focus¶¶¶
Adverse event rate SafeOutcome X
Safe practices implementation SafeProcess X X
Healthcare acquired condition rate§ SafeOutcome X
Functional health outcome score EffectiveOutcome X X
Hospital 30-day readmission rate** EffectiveOutcome X X
Evidence-based care score†† EffectiveExperience X X
Patient experience score‡‡ Patient centredExperience X X X
Care transition measure score§§ Patient centredExperience X X X
Health risk status score¶¶ Patient centredOutcome X X
Rate of same day access*** TimelyExperience X
Hospital days per decedent last 6 months of life††† EfficientCosts X X
Healthcare costs per capita‡‡‡ EfficientCosts X X X
Equity: stratify measures§§§ EquitableAll X X X
  • * Contents of table 1 based on the IHI White Paper15: Whole System Measures (2007); recommendations from the Marketplace Collaborative sponsored by Virginia Mason; and recommendations from the National Quality Forum, National Priorities Partnership and Centers for Medicare and Medicaid Services (CMS) for high-priority quality measures. To balance metrics across the continuum of care future metrics for home health, skilled nursing facilities and hospice will need to be incorporated.

  • Adverse event rate based on selected global trigger tool score or CMS metrics from Partnership for Patients.

  • Implementation of the National Quality Forum endorsed Safe Practices for Better Healthcare. (accessed 1 Sep 2011).

  • § Healthcare acquired condition rate based on CMS inpatient care quality measure.

  • Functional health outcome score based on Veterans RAND 12-Item Health Survey or PROMIS-10 annual change scores for selected populations of chronic disease patients (eg, heart failure, asthma, osteoarthritis of knee, depression, etc.).

  • ** Hospital 30-day readmission rate based on CMS inpatient care quality measure.

  • †† Evidence-based care score based on core measure composite scores for outpatient and inpatient care.

  • ‡‡ Patient experience score based on Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CGCAHPS) (outpatient) and hospital Consumer Assessment of Healthcare Providers and Systems (inpatient) composite scores.

  • §§ Care transition measure (CTM) score based on Coleman's three-item CTM index.

  • ¶¶ Health risk status score based on an index of major risks of morbidity and mortality such as the Framingham Index or alternate validated measure of health risk based on biometric variables (eg, blood pressure, cholesterol, haemoglobin A1c) and health behaviours (eg, tobacco use, alcohol use and seat belt use) and demographic variables (eg, age, gender, race, ethnicity).

  • *** Rate of same day access based on patient-reported question/s in CGCAHPS or data on third next available appointment in outpatient scheduling system for patients seeking an appointment as soon as possible.

  • ††† Hospital days per decedent last 6 months of life based on Dartmouth Atlas and/or other claims data.

  • ‡‡‡ Healthcare costs per capita based on Dartmouth Atlas data and/or other claims data.

  • §§§ The Institute of Medicine aim of equity can be measured under this framework by reporting the metrics included herein by race, ethnicity and socio-economic status.

  • ¶¶¶ Population focus refers to a geographically defined population such as community residents or another type of population such as people who are attributed to an accountable care organization or to a primary care medical home or employees and dependents of an employer organisation.