Getting More Performance from Performance Measurement

Cassel, Christine K.; Conway, Patrick H.; Delbanco, Suzanne; Jha, Ashish K.; Saunders, R. S.; Lee, Thomas H.

doi:10.1056/nejmp1408345

Cited by 84 publications

(67 citation statements)

References 2 publications

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“…14,20,21 In aggregate, these programs can stretch hospitals’ resources to their limit. Respondents universally reported that the SEP-1 program is requiring dedicated staff to meet the data abstraction and reporting requirements as well as multicomponent quality-improvement initiatives.…”

Section: Discussionmentioning

confidence: 99%

Hospital Perceptions of Medicare's Sepsis Quality Reporting Initiative

Barbash

Rak

Kuza

et al. 2017

Journal of Hospital Medicine

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BACKGROUND In October 2015, the Centers for Medicare and Medicaid Services (CMS) implemented the Sepsis CMS Core Measure (SEP-1) program, requiring hospitals to report data on the quality of care for their patients with sepsis. OBJECTIVE We sought to understand hospital perceptions of and responses to the SEP-1 program. DESIGN A thematic content analysis of semistructured interviews with hospital quality officials. SETTING A stratified random sample of short-stay, nonfederal, general acute care hospitals in the United States. SUBJECTS Hospital quality officers, including nurses and physicians. INTERVENTION None. MEASUREMENTS We completed 29 interviews before reaching content saturation. RESULTS Hospitals reported a variety of actions in response to SEP-1, including new efforts to collect data, improve sepsis diagnosis and treatment, and manage clinicians’ attitudes toward SEP-1. These efforts frequently required dedicated resources to meet the program’s requirements for treatment and documentation, which were thought to be complex and not consistently linked to patient-centered outcomes. Most respondents felt that SEP-1 was likely to improve sepsis outcomes. At the same time, they described specific changes that could improve its effectiveness, including allowing hospitals to focus on the treatment processes most directly associated with improved patient outcomes and better aligning the measure’s sepsis definitions with current clinical definitions. CONCLUSIONS Hospitals are responding to the SEP-1 program across a number of domains and in ways that consistently require dedicated resources. Hospitals are interested in further revisions to the program to alleviate the burden of the reporting requirements and help them optimize the effectiveness of their investments in quality-improvement efforts.

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Section: Discussionmentioning

confidence: 99%

Hospital Perceptions of Medicare's Sepsis Quality Reporting Initiative

Barbash

Rak

Kuza

et al. 2017

Journal of Hospital Medicine

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“…In the decades past, because of this complexity, measuring performance in the health care sector was uncommon and, in fact, it was believed that quality was not measurable. But today there is a higher interest in measuring and reporting performance in this sector, and in some cases there is the problem of having too many measures, some of which focus on outputs, outcomes, and processes, and others on single activities that have limited effect on overall health (Cassel et al 2014).…”

Section: Literature Reviewmentioning

confidence: 99%

Performance Management Uses, Outcome Measures and Mechanisms-Based Explanations. The Case of the Judicial Sector

Vecchi

2017

System Dynamics for Performance Management

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The public sector performance management (PM) literature is particularly rich as this topic is one of the most appealing for public sector scholars (Pollitt, J Public Adm Res Theory 6:25-44, 2005). However, organizational performance (OP) has been neglected across the world (Andrews et al. J Public Adm Res Theory 21:i301-i319, 2011) as well as in the Italian public administration (Martin and Spano, Public Money Manag 35:303-310, 2015). This chapter investigates how OP is defined, measured, and evaluated in the Italian health care sector. Our analysis showed the limited use of performance management in Italian public health organizations and a high variability in the way OP is defined and measured. This makes it difficult to compare the results of different organizations. For this reason, future standardization could allow policy makers to improve the accountability.Keywords Organizational performance Á Health care Á Italian public sector IntroductionThe issue of OP is of particular relevance in the healthcare sector, where the impact of health organizations on individuals' lives is significant and measures of OP are required to understand the extent to which these organizations are effective. Even though significant progress has been made in building more advanced performance measurement systems in the health care sector, more work is needed (Smith et al. 2008). In fact, the literature on performance management in the health care sector reports several cases of incorrect uses and, even misuses of performance measures and targets with the introduction of a kind of "governance by targets" and a Traditionally, performance in health care has been measured using specific indicators such as incidence of pathology, mortality measures, and measures of mortality after a specific treatment. Other measures are increasingly attractive, including those that focus on patient health status, which are often in the form of outcome measures (Smith et al. 2008). However, there is a limited "understanding of how performance measurement can be organized to support improvement initiatives in health care practices" (Elg et al. 2013).In the Italian public sector, the role of OP has been largely neglected, and more importance has been given to individual performance (Martin and Spano 2015). As far as the healthcare sector is concerned, OP is attracting increased attention in Italy, but there is still a lack of extensive research on this topic. For example, there is a high variation in the way OP is defined and, consequently, measured. In particular, a comprehensive analysis of the current OP practices as measured by Italian health care organizations is still missing. For this reason, our research aims at addressing the following research questions (RQs):RQ1: How do Italian health care organizations define OP? RQ2: Is OP measured by Italian health care organizations, and if so, how?This chapter is organized into six sections: (1) literature review on OP with specific reference to the health care sector; (2) the Italian health ...

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“…The measurement of health outcomes is necessary to assess quality and facilitate improvement [31]. The IOM lists nine types of quality metrics-structure, process, clinical outcomes, patient-reported outcomes (PRO), patients' perspective on care, cost, efficiency, cross-cutting, and diseasespecific [2••].…”

Section: What Tensions Exist Between Pcc and Vbc?mentioning

confidence: 99%

Value Based Care and Patient-Centered Care: Divergent or Complementary?

Tseng

Hicks

2016

Curr Hematol Malig Rep

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Two distinct but overlapping care philosophies have emerged in cancer care: patient-centered care (PCC) and value-based care (VBC). Value in healthcare has been defined as the quality of care (measured typically by healthcare outcomes) modified by cost. In this conception of value, patient-centeredness is one important but not necessarily dominant quality measure. In contrast, PCC includes multiple domains of patient-centeredness and places the patient and family central to all decisions and evaluations of quality. The alignment of PCC and VBC is complicated by several tensions, including a relative lack of patient experience and preference measures, and conceptions of cost that are payer-focused instead of patient-focused. Several strategies may help to align these two philosophies, including the use of patient-reported outcomes in clinical trials and value determinations, and the purposeful integration of patient preference in clinical decisions and guidelines. Innovative models of care, including accountable care organizations and oncology patient-centered medical homes, may also facilitate alignment through improved care coordination and quality-based payment incentives. Ultimately, VBC and PCC will only be aligned if patient-centered outcomes, perspectives, and preferences are explicitly incorporated into the definitions and metrics of quality, cost, and value that will increasingly influence the delivery of cancer care.

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Getting More Performance from Performance Measurement

Cited by 84 publications

References 2 publications

Hospital Perceptions of Medicare's Sepsis Quality Reporting Initiative

Hospital Perceptions of Medicare's Sepsis Quality Reporting Initiative

Performance Management Uses, Outcome Measures and Mechanisms-Based Explanations. The Case of the Judicial Sector

Value Based Care and Patient-Centered Care: Divergent or Complementary?

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