When developing a quality strategy it is helpful to remember that there are three main types of quality measures that should be considered: process measures, outcome measures, and structure measures. The following definitions are based on information provided by the AHRQ National Quality Measures Clearinghouse.
- Process Measures. A process of care is a health care related activity performed for, or on behalf of, a patient. Process measures are supported by evidence that the clinical process – that is, the focus of the measure – has led to improved outcomes. An example of a process measure would be the percent of patients with hypertension who received timely blood pressure screens.
- Outcome Measures. An outcome of care is a health state of a patient resulting from health care. Outcome measures are supported by evidence that the measure has been used to detect the impact of one or more clinical interventions. An example of an outcome measure would be the percent of patients with hypertension whose blood pressure is under control.
- Structure Measures. Structure of care is a feature of a health care organization or clinician related to the capacity to provide high quality health care. Structure measures are supported by evidence that an association exists between the measure and one of the other clinical quality measure domains. An example of a structure measure would be whether the health care organization maintains a register of patients with established hypertension.
Some organizations recommend two additional categories of measures including patient experience measures and access measures. However these types of measures are not as widely used, and they may also be included as appropriate under one of the three main categories outlined above.
Focusing on PCMH development, the PCMH model is based on recommended practices for the structure of health care. In this context, implementation of the PCMH standards and elements can be viewed as structural indicators of quality.