Hospital and Outpatient Quality Metrics: An Annotated Bibliography

Hospital and Outpatient Quality Metrics

Hospital Outpatient Quality Reporting Specifications Manual

Description: The Hospitals Outpatient Quality Reporting Specifications Manual was developed by the Centers for Medicare and Medicaid Services to provide a uniform set of quality measures to be implemented in hospital outpatient settings.  The primary purpose of these measures is to promote high quality care for patients receiving services in hospital outpatient settings.

Keywords:  hospital quality metrics, outpatient-reporting manual, CMS

Audience:  hospitals, physicians, administration

National Quality Forum

Description: The National Quality Forum (NQF) has provided a wide variety of ambulatory care measures for assessment of the quality of care in outpatient facilities, including hospital outpatient departments, emergency department, urgent care facilities, surgery centers, and clinician offices.  NQF’s measures are intended to encourage hospitals and clinicians to improve their quality of care and to empower consumers with quality information to make informed decisions about their healthcare.

Keywords:  NQF, ambulatory care measures, hospitals quality of care

Audience:  hospital outpatient departments, surgery centers, clinicians

Hospital Outpatient Quality Reporting Program

Description: The Hospital Outpatient Quality Reporting Program is a pay for quality reporting program implemented by the Centers for Medicare and Medicaid Services for outpatient hospital services.  The Hospitals Quality Reporting Program was mandated by the Tax Relief and Health Care Act of 2006, which requires hospitals to submit data on measures of the quality of care furnished by hospitals in outpatient settings.  Measures of quality are in various types, such as process, structure, outcome, and efficiency.

Keywords:  quality reporting program, Tax Relief and Health Care Act, outpatient measures

Audience:  hospitals, outpatient clinics, physicians

CRC Press

Description: CRC press provides a valuable reference for those involved in the field of ambulatory care.  This reference offers time tested instruction on how to create a world class outpatient program.  It supplies a high level overview of current opportunities, national quality programs, and challenges.  This reference also outlines the policies, procedures, and plans required for success.

Keywords:  ambulatory surgery centers, control chart, NQF

Audience:  surgeons, physicians, administration

Hospital Compare

Description: The consumer website called Hospital Compare was formed on April 1, 2005.  This resource provides instant, objective, easy to use and free information about the quality of hospital care nationwide.  Under the Hospital Quality Initiative, hospitals submit quality of care information so that consumers can compare and make better-informed decisions.

Keywords:  Hospital Compare, Hospital Quality Initiative, quality of hospital care

Audience:  physicians, hospitals, consumers

Hospital Patient Perspective on Care Survey

Description: The purpose of the Hospital Patient Perspective on Care Survey (HCAHPS) is to provide a standard survey and data collection method for measuring patients’ perspectives on hospital care.  HCAHPS can be viewed as a core set of question that can be combined with a broader, customized set of hospital-specific terms.  HCAHPS is meant to compliment the data hospitals currently collect to support improvement in internal customer service and quality related activities.

Keywords:  HCAHPS, patient surveys, hospital quality improvement

Audience:  hospitals, risk and quality management, providers

Outpatient Quality Reporting Program

Description: The Outpatient Quality Reporting Program is a quality data-reporting program that is implemented by the Centers of Medicare and Medicaid Services for outpatient hospital services.  Under this program, hospitals report data using standardized measures of care to receive the full annual update to their Outpatient Prospective Payment System payment rate.  This website offers further resources on the Quality Outpatient Reporting Program.

Keywords:  OQR, OPPS, outpatient measurement

Audience:  hospitals, physicians, healthcare centers

American College of Physicians

Description: This article presents clinicians with a concept on how to assess hospital quality reports.  This article also illustrates a pattern of measuring quality in terms of structure, process, and outcome by using examples from clinical and health services research literature to illustrate advantages and disadvantages for each category.  In addition, because productive quality measurement must stimulate quality improvement this article touches on the relationship between these two activities.

Keywords:  assessing hospital quality, review for clinicians, ACP

Audience:  clinicians, hospitals, healthcare providers

Agency for Healthcare Research and Quality

Description: As part of a goal to support a culture of patient safety and quality improvement in the Nation’s health care system, the Agency for Healthcare Research and Quality sponsored the development of patient safety culture assessment tools for hospitals, nursing homes, ambulatory outpatient medical offices, and pharmacies.  Four surveys on patient safety culture are available and health care organizations can use these survey assessment tools to raise staff awareness, diagnose and assess, identify strengths, and examine trends.

Keywords:  AHRQ, patient survey, hospital and outpatient quality

Audience:  hospitals, outpatient medical offices, pharmacies

Hospitals in Pursuit of Excellence

Description: The Hospital in Pursuit of Excellence (HPOE) is the American Hospital Association’s strategic program to accelerate performance improvement and support delivery systems transformation in the nation’s hospitals.  HPOE provides education on best practices, evidence based tools and guides, leadership development through networks, national improvement projects, and collaboration with hospital association and national partners.

Keywords:  HPOE, AHA program, hospital improvement projects

Audience:  hospitals, providers, administration

Hospital Engagement Network

Description: The Hospital Engagement Network (HEN) assists to identify solutions already working to reduce healthcare acquired conditions, and establish ways to spread them to other hospitals and healthcare providers.  HEN is developing learning collaborative for hospitals and provides a wide assortment of activities to improve patient safety.  Intensive training programs are being conducted to teach and support hospitals in making patient care safer, provide technical assistance so that hospitals can achieve quality measurement goals, and establish and implement a system to track and monitor hospital progress in meeting quality improvement goals.

Keywords:  HEN, quality measurement goals, hospital progress monitor

Audience:  hospitals, healthcare providers, nurses


Description: The Team Strategies to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence based set of teamwork tools that are aimed at optimizing patient outcomes by improving communication and teamwork skills among healthcare professionals.  These tools include a comprehensive set of ready to use materials and a training curriculum to successfully integrate teamwork principles into any healthcare system.

Keywords:  TeamSTEPPS, healthcare teams, teamwork tools

Audience:  healthcare professionals, administrations, healthcare managers

Health Research and Educational Trust Disparities Toolkit

Description: The Health Research and Educational Trust Disparities Toolkit is a web based tool that provides hospitals, health systems, clinics, and health plans information and resources for systematically collecting race, ethnicity, and primary language from patients.  This toolkit is useful for educating and informing staff on the importance of data collection.  This toolkit also shows staff how data can be used to improve hospital and outpatient measures.

Keywords:  HRET Disparities Toolkit, data toolkit, data collection

Audience:  health systems, clinics, health plans

Association for Community Health Improvement

Description: The Association for Community Health Improvement is a national association for community health, community benefit, and health community professionals.  The Association for Community Health Improvement delivers education, professional development; peer networking and practical tools that help a healthcare organization expand their knowledge and enhance performance in achieving goals.

Keywords:  community health improvement, professional development, healthcare networking

Audience:  healthcare centers, physicians, hospitals

Center for Healthcare Governance

Description: The Center for Healthcare Governance is a community of hospital and health system board members, executive and leaders who are dedicated to advancing excellence, innovation and accountability in healthcare governance.  Membership with the Center for Healthcare Governance will provide a professional with access to information and resources from healthcare strategic planning and hospital performance to the leading practices in governance and board development.

Keywords:  CENTER, healthcare governance, healthcare strategic planning

Audience:  hospitals, healthcare professionals, healthcare managers

Hospital Value-based Purchasing Program

Description: Under the Hospital Value-based Purchasing Program the CMS will make value-based incentive payments to acute care hospitals, based on how well the hospitals perform on certain quality measures or how much the hospitals’ performance improved on certain quality measures.  The higher a hospitals’ performance or improvement during the performance period for a fiscal year, the higher the hospitals’ value-base incentive payment will be.  This website offers more details and resources to help hospitals, patients, and other quality stakeholders take full advantage of the program’s possibilities.

Keywords:  value-based purchasing program, quality measures, hospital performance

Audience:  hospitals, patients, quality stakeholders


Description: Masspro is actively engaged in work with quality professionals at hospitals statewide, in support of quality data collection, submission, and use for process improvement.  Masspro is committed to strengthening the quality improvement outreach.  In addition to state-wide outreach, Masspro provides technical support to hospitals requesting assistance with the collection, submission, or use of quality data for quality improvement.  Service includes assistance with data reporting rules, coaching on reporting interfaces, and assistance with feedback reports.

Keywords:  Masspro, hospital quality measurement, data collection

Audience:  hospitals, physicians, administration

Meridian Health

Description: This reference material was assembled to provide a healthcare provider with detailed information on Meridian’s quality indicators.  These indicators represent best practice evidence based care for a selected group of patients.  The selected group of patients would have acute myocardial infarction, heart failure, pneumonia, surgical care improvement, children’s asthma, stroke, outpatient surgery, and outpatient chest pain, Meridian submits data on these indicators as required to the Centers for Medicare and Medicaid and The Joint Commission for public reporting.

Keywords:  Meridian Health, quality indicators, outpatient metrics

Audience:  healthcare provider, hospitals, outpatient facilities

The Journal of Rural Health

Description: Quality measures focused on outpatient setting are of increasing interest to policy makers, but little research has been conducted on hospital outpatient quality measures, especially in rural settings.  This article shows how researchers analyzed Medicare hospital outpatient claims and Hospital Compare outpatient measure data for rural hospitals to assess the volume of conditions addressed by the measures in rural hospitals.  A panel of rural hospital quality experts reviewed the measures and provided additional input about their usefulness and data collection issues in rural hospitals.

Keywords:  hospital, Medicare, outpatient, quality

Audience:  hospitals, outpatient facilities, physicians

Center to Advance Palliative Care

Description: In the past years, the National Quality Forum issued a report detailing 38 Preferred Practices for Palliative and Hospice Care Quality.  The National Quality Forum used the Clinical Practice Guidelines for Quality Palliative Care as the starting point for developing Preferred Practices.  The Center to Advance Palliative Care has developed this document to provide a crosswalk between The Joint Commission standards and palliative care.  This document will assist programs in developing the necessary policies and associated clinical tools and resources to ensure that a palliative care program meets the National Quality Forum’s Preferred Practices.

Keywords:  NQF Preferred Practices, palliative care programs, CAPC

Audience:  palliative care programs, physicians, healthcare programs

Press Ganey

Description: Press Ganey’s Quality Performer helps clients boost improvement and optimize reimbursement.  This solution brings together quality measures, data collection, analysis tools, proven resources, and educational, training, and support staff to help clients interpret their data and form improvement plans.  Quality Performer supports federal, state and regulatory reporting requirements in addition to accreditation reporting requirements.  Press Ganey’s expertise in quality measures and eMeasures readiness ensures clients receive the support and resources they need to master the complexities of all CMS and The Joint Commission quality data reporting requirements.

Keywords:  Press Ganey, quality measures, data collection

Audience:  risk and quality management, physicians, healthcare organizations

Alliant GMCF

Description: Alliant GMCF is an independent, objective and trusted partner of organizations that represent healthcare providers.  They bring evidence-based best practices to the bedside, while sharing knowledge and tools for improving health quality, efficiency and value. As part of the national network of Quality Improvement Organizations, they focus on three aims: better patient care, better population health, and lower health care costs through improvement.

Keywords:  Alliant GMFC, hospital quality measures, quality improvement

Audience:  healthcare providers, hospitals, administration

RAND Health

Description: RAND Health has developed tools to enable healthcare organizations to measure the quality of inpatient or outpatient clinical care practically and reliably.  Quality of outpatient care is assessed in five areas: prevention and screening, minor illnesses and chronic illnesses, acute illness episodes, communication, education, access to care, and overall quality.  The review forms for both inpatient and outpatient care and the instruction manuals for using them are available directly from RAND.

Keywords:  RAND Health, quality measures, outpatient care

Audience:  outpatient facilities, inpatient facilities, healthcare providers

ASC Quality Measures: Implementation Guide

Description: The ASC Quality Collaboration encourages healthcare professionals to use the standardized quality measures for the ASC setting that has been endorsed by the National Quality Forum.  These measures are described in detail in this implementation guide.  ASC hopes healthcare professionals will find these measures useful for not only internal quality improvement and external benchmarking, but also for meeting future Medicare requirement for quality reporting.

Keywords:  ASC Quality Collaboration, quality measures, quality reporting

Audience:  healthcare organizations, physicians, risk and quality management

National Institutes of Health

Description: Most healthcare providers provide mobile service for their medical staff; however, few healthcare providers provide mobile service as part of their outpatient service.  The mobile outpatient service system (MOSS) focuses on illness treatment, illness prevention and patient relation management for outpatient service users.  This study focuses on the development of the MOSS and how the MOSS might improve outpatient services.

Keywords:  MOSS, outpatient services, outpatient service system

Audience:  healthcare providers, outpatient facilities, hospitals

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