Outcomes improvement can’t happen without effective outcomes measurement. Given the healthcare industry’s administrative and regulatory complexities, and the fact that health systems measure and report on hundreds of outcomes annually, this blog adds much-needed clarity by reviewing the top seven outcome measures, including definitions, important nuances, and real-life examples: Mortality Readmissions Safety of care Effectiveness of care Patient experience Timeliness of care Efficient use of medical imaging CMS used these exact seven outcome measures to calculate overall hospital quality and arrive at its 2016 hospital star ratings. This blog also reiterates the importance of outcomes measurement, clarifies how outcome measures are defined and prioritized, and recommends three essentials for successful outcomes measurement: Transparency Integrated care Interoperability

1. The Top 7 Outcome Measures and
3 Measurement Essentials
― ANN TINKER

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Outcome Measurement
The healthcare industry is riddled
with administrative and regulatory
complexities that make it difficult for
health systems to achieve the Triple
Aim of healthcare.
Complexities in outcomes
improvement are particularly
challenging, as health systems
measure and report on hundreds of
outcomes annually.

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Outcome Measures Defined
Outcome measures (mortality, re-
admission, patient experience, etc.) are
the quality and cost targets healthcare
organizations are trying to improve.
“…change in the health of an
individual, group of people, or
population that is attributable
to an intervention or series of
interventions.”
— World Health Organization

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Outcome Measures Defined
Outcome measures are frequently
reported to the government, commercial
payers, and organizations that report on
quality, such as The LeapFrog Group—
a national nonprofit that evaluates and
reports U.S. hospital safety and quality
performance.
LeapFrog’s work centers on “increasing
transparency among health care
providers in order to reduce the
estimated 440,000 annual deaths from
hospital errors, accidents, and injuries.”

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Why Measuring Outcomes Is Important
The ultimate goal of measuring, reporting,
and comparing health outcomes is to
achieve the Triple Aim of healthcare:
Institute for Healthcare Improvement (IHI): Triple Aim
Improve the patient experience of care.
Improve the health of populations.
Reduce the per capita cost of healthcare.

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Why Measuring Outcomes Is Important
The organization behind the Triple
Aim—the Institute for Healthcare
Improvement (IHI)—is dedicated to
outcomes improvement. IHI
describes measurement as “a
critical part of testing and
implementing changes.
Measures tell a team whether the
changes they are making actually
lead to improvement.” Healthcare
organizations, motivated by the
Triple Aim, measure outcomes for
many reasons…

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Why Measuring Outcomes Is Important
Healthcare organizations, motivated
by the Triple Aim, measure
outcomes for many reasons:
• Reveal areas in which interventions
could improve care.
• Identify variations of care.
• Provide evidence about interventions
that work best for certain types of
patients under certain circumstances.
• Compare the effectiveness of various
treatments and procedures.

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Outcome Measures Are Driven by National
Standards and Financial Incentives
Outcome measures are primarily
defined and prioritized by national
organizations, including CMS, The
Joint Commission (TJC), and the
National Association for Healthcare
Quality (NAHQ).
Health systems target outcome
measures based on state and
federal government mandates,
accreditation requirements, and
financial incentives.

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Outcome Measures Are Driven by National
Standards and Financial Incentives
Although outcomes and targets are
defined at the national level, health
systems might set more aggressive
targets.
Meeting and exceeding national
targets benefits not only quality of
care, but also marketing and
contracting.

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Outcome Measures Are Driven by National
Standards and Financial Incentives
TJC is a regulatory body that
accredits health systems and has
national standards for quality
measures that are “developed with
input from healthcare professionals,
providers, subject matter experts,
consumers, government agencies
(including CMS) and employers.”

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Outcome Measures Are Driven by National
Standards and Financial Incentives
New standards must meet strict requirements:
• Relate to patient safety or quality of care.
• Positively impact health outcomes.
• Meet or surpass law and regulation.
• Can be accurately and readily measured.

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Outcome Measures Are Driven by National
Standards and Financial Incentives
Reporting and accreditation entities
have processes in place to normalize
outcomes data to account for context,
which is key when it comes to reporting.
It’s easy to take data out of context.
Using fall rates as an example, if a
small, 10-bed hospital sees ten patients
in one month and one patient falls, then
their fall rate is high (10 percent).

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Outcome Measures Are Driven by National
Standards and Financial Incentives
CMS uses outcome measures to calculate overall hospital
quality. In a recent report, CMS explained how it arrived at
its 2016 hospital star ratings. CMS grouped outcome
measures into seven categories weighted by importance:
• Mortality (22%)
• Safety of care (22%)
• Readmissions (22%)
• Patient experience (22%)
• Effectiveness of care (4%)
• Timeliness of care (4%)
• Efficient use of medical imaging (4%)

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The Top Seven Outcome Measures Explained
There are hundreds of outcome
measures, ranging from changes in blood
pressure in patients with hypertension to
patient-reported outcome measures
(PROMs).
The seven outcome measures CMS uses
to calculate hospital quality are some of
the most common in healthcare:

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The Top Seven Outcome Measures Explained
There are hundreds of outcome
measures, ranging from changes in blood
pressure in patients with hypertension to
patient-reported outcome measures
(PROMs).
The seven outcome measures CMS uses
to calculate hospital quality are some of
the most common in healthcare:

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Mortality (life expectancy)
The Top Seven Outcome Measures Explained
Mortality is an essential population
health outcome measure.
For example, MultiCare Health System’s
initiative to improve the care, cost, and
experience of pneumonia patients,
reduced the pneumonia mortality rate by
28 percent.
1

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Readmissions
The Top Seven Outcome Measures Explained
Readmission following hospitalization is a
common outcome measure. Readmission is
costly (and often preventable).
For example, MultiCare Health System
reduced pneumonia readmissions by 23
percent by building evidence-based order
sets, assigning a team of social workers to
improve patient follow-up and communica-
tion, and deploying an analytics application
to provide near real-time feedback on
compliance and performance.
2

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Safety of Care
The Top Seven Outcome Measures Explained
Safety of care outcome measures pertain to
medical mistakes. Skin breakdown and
hospital acquired infections (HAIs) are
common safety of care outcome measures:
3
Happens when pressure
decreases blood flow to the
skin. A skin assessment tool
can be used to reduce skin
breakdown. Patients with
skin breakdown are at a
higher risk of infection.
Skin breakdown
Caused by viral, bacterial,
and fungal pathogens.
Texas Children’s identified
evidence-based bundles to
reduce HAIs in children
and decreased HAIs by
35 percent.
HAIs

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Patient Experience
The Top Seven Outcome Measures Explained
Readmission following hospitalization is a
common outcome measure. Readmission
is costly (and often preventable).
For example, MultiCare Health System
reduced pneumonia readmissions by 23
percent by building evidence-based order
sets, assigning a team of social workers to
improve patient follow-up and communica-
tion, and deploying an analytics
application to provide near real-time
feedback on compliance and performance.
4

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Effectiveness of Care
The Top Seven Outcome Measures Explained
Effectiveness of care outcome measures
evaluate two things:
• Compliance to best practice care guidelines.
• Achieved outcomes (e.g. lower readmission
rates for heart failure patients).
5
It’s important to track clinician compliance
to care guidelines.
It’s equally important to monitor treatment
outcomes and alert clinicians when care
guidelines need to be reviewed.

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Timeliness of Care
The Top Seven Outcome Measures Explained
Timeliness of care outcome measures
assess patient access to care.
For example, a health system working to
design a more efficient and accurate system
for assessing sepsis developed an analytics
platform to track the timeliness of care
delivery, including several interventions:
lactate tests, blood cultures, antibiotics, and
central venous pressure (CVP).
6

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Efficient Use of Medical Imaging
The Top Seven Outcome Measures Explained
The efficient use of medical imaging is an
increasingly important outcome measure.
7
“Medical imaging plays a central
role in the global healthcare
system as it contributes to
improved patient outcome and
more cost-efficient healthcare in
all major disease entities.”
— European Science Foundation

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Process Measures Are Equally Important
Achieving outcomes is important, but the
process by which we achieve outcomes is
equally important.
Process measures capture provider
productivity and adherence to standards of
recommended care.
For example, if a health system wants to
reduce the incidence of skin breakdown, then
it might implement the process measure of
performing a risk assessment using the
Barden Scale for reducing pressure ulcer risk
in all the appropriate units in the hospital.

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Process Measures Are Equally Important
The following outcome and process
measures illustrate how health systems
improve outcomes by improving processes:
Can reduce heart failure
readmission rates.
Outcome Measure
Conducting a medication
reconciliation system check
with heart failure patients
at the time of discharge.
Process Measure

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Process Measures Are Equally Important
The following outcome and process
measures illustrate how health systems
improve outcomes by improving processes:
Can reduce fall rates.
Outcome Measure
Performing a fall risk
assessment on a patient at
the time of admission
Process Measure

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Process Measures Are Equally Important
The following outcome and process
measures illustrate how health systems
improve outcomes by improving processes:
Can prevent skin
breakdown.
Outcome Measure
Using a skin
assessment tool.
Process Measure
[See Also: Why Process Measures Are Often More Important Than Outcome Measures in Healthcare]

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Three Essentials For Successful Outcomes Measurement
Health systems’ ultimate goal is to improve
patient outcomes. But outcomes
improvement can’t happen without
effective outcomes measurement.
As health systems work diligently to
achieve the Triple Aim of healthcare, they
need to prioritize three outcomes
measurement essentials: transparency,
integrated care, and interoperability.

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Transparency
The Top Seven Outcome Measures Explained
The healthcare industry is on a journey to
outcomes transparency. Patients want
outcomes data so they can make educated
decisions about their healthcare.
Quality reporting organizations, such as The
LeapFrog Group, evaluate and report U.S.
hospital safety and quality performance.
Patients want reassurance they’re receiving
the best care for the lowest cost—publicly
reported outcomes help.
1

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Integrated Care
The Top Seven Outcome Measures Explained
The industry is also shifting toward
integrated care—we aren’t just treating a hip
anymore; we’re treating the whole person.
A key to integrated care is helping patients
with transitions―easing them from the ER,
to surgery, to inpatient care, to rehab, and
back to a steady, normal state.
Transitional points of care are critical for
managing consistency of care and
providing the right care in the right
setting at the lowest cost.
2

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Interoperability
The Top Seven Outcome Measures Explained
Sharing data between departments within an
integrated system is another important
component.
Outcomes measurement and improvement
depends on the system’s ability to share data
across clinicians, labs, hospitals, pharmacies,
and other staff, departments, and settings.
EDWs improve interoperability by integrating
data and providing a single source of truth.
2

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The Triple Aim:
Outcomes measurement should always tie back
to the Triple Aim (improve the patient experience,
improve the health of populations, and reduce
costs) so we’re not just reporting numbers.
The Ultimate Goal of Outcomes Measurement
Institute for Healthcare Improvement (IHI): Triple Aim
The focus should be on quality and
improving the care experience at the
lowest cost.
We don’t want to become so obsessed
with numbers that we forget our
Triple Aim goal.

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For more information:
“This book is a fantastic piece of work”
– Robert Lindeman MD, FAAP, Chief Physician Quality Officer

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More about this topic
Why Process Measures Are Often More Important Than Outcome Measures in Healthcare
Tom Burton, Product Development, SVP
Improving Healthcare Outcomes: Keep the Triple Aim in Mind
Michael Barton, Engagement Executive, VP - Tracy Vayo, Director, Knowledge Development
Kathleen Merkley, Clinical Improvement, VP
Why Most Analytic Applications Will Never Be Able to Significantly Improve Healthcare Outcomes
Dan Soule, Vice President of Product Management
Quality Improvement in Healthcare: Where is the Best Place to Start?
Eric Just Eric Just, Technology, VP
6 Steps for Implementing Successful Performance Improvement Initiatives in Healthcare Report)
Bobbi Brown, VP of Financial Engagement - Leslie Falk, Customer Engagement, VP
Link to original article for a more in-depth discussion.
The Top 7 Outcome Measures and 3 Measurement Essentials

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Ann Tinker joined Health Catalyst in June of 2012 as a Vice President for
Customer Engagements. Prior to coming to Health Catalyst, she worked for GE
Healthcare IT on the GE/Intermountain Healthcare partnership product called
Qualibria as a Product Manager and Customer liaison. Ann worked PRN (on-
call) for LDS Hospital in the Post Anesthesia Care Unit (PACU) as a staff RN for
the past 6+ years. Before GE Ann was employed at 3M HIS business based in Salt Lake
City working in a variety of positions from sales support, implementation, development,
marketing and product management for both US and International products and prior to
then worked for Intermountain Healthcare for 10+ years in Critical Care and Nursing
Administration. Ann has a bachelor’s degree in nursing from Brigham Young University and
a Masters from University of Washington.
Other Clinical Quality Improvement Resources
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