The University Research Co. LLC defines quality improvement as a process using quantitative and qualitative methods to improve the effectiveness, efficiency, and safety of service delivery processes and systems, as well as the performance of human resources in delivering products and services.
The Center for Medicare and Medicaid Services defines quality measures as tools that help us measure or quantify healthcare processes, outcomes, patient perceptions, and organizational structure and/or systems that are associated with the ability to provide high-quality health care and/or that relate to one or more quality goals for health care.
Quality measures follow the Structure Process Outcome framework to address the inputs and outputs of healthcare. The following definitions were provided by the Pharmacy Quality Alliance.
Quality measure development strategies vary according to the organization. However, credible measures go through rigorous processes that include approval or endorsement from advisement groups or panelists. Organizations pride themselves on paneling diverse healthcare experts to ensure relevance and value of their measures in the market.
Quality measures are used to evaluate health care services to improve patient care. Additionally, they are being used in payment models to determine reimbursements and network status for providers.
The Affordable Care Act brought the issue of quality to the forefront of healthcare. With the push to shift from fee-for-service to pay-for-performance, quality measures became a useful tool to guide the transition between the two payment models. The ACA also contained provisions for an entity charged with creating a national quality strategy.
Pharmacists can use their medication expertise to help providers reach their medication-related and other health care quality benchmarks. Incentives are emerging for pharmacists to be financially rewarded for their contributions. Likewise, opportunities are emerging for pharmacies to use performance on quality measures to gain preferred network statuses or have lower co-payments for patients.