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Learning Objectives

After completing this chapter, the reader will be able to

  • Explain the changing environment for quality measurement and performance reporting in health care.

  • Define quality and value in the context of health care services.

  • Delineate the concepts of structure, process, and outcomes for quality assessment.

  • Describe a systematic method for quality improvement.

  • Explain the role of performance indicators in quality improvement.

  • Draft a performance indicator related to the medication use system.

  • Discuss quality improvement techniques applied in drug information practice.

Key Concepts

  1. The term value has been assigned many definitions, but within health care, it usually reflects the ratio of quality and costs (value = quality/cost).

  2. Significant drivers for greater transparency in the quality and value of health care services include the federal government, employers that provide health care benefits, and accreditation organizations such as The Joint Commission (TJC).

  3. Quality improvement is prospective, continuous, team oriented, nonpunitive, systems oriented, customer focused, and data driven.

  4. A common methodology for quality improvement is known as FOCUS-PDCA (Find, Organize, Clarify, Understand, Select, Plan, Do, Check, Act).

  5. The Donabedian framework for quality assessment in health care includes the key elements of structure, process, and outcomes.

  6. Performance indicators are used to measure quality as part of the check function of quality improvement. The indicators typically focus on the process or outcomes of a care system.

  7. Performance indicators can be subdivided into sentinel (occurrence of a serious event) or aggregate categories. Aggregate indicators are further divided into continuous or rate-based indicators.

  8. Medication use evaluation is often part of an organization’s overall performance improvement program that uses definitions of safe and effective use of medications to assess components of the medication use process.

  9. Performance, as demonstrated by data collected in the performance improvement process, not meeting the defined standard or threshold or falling outside the control limits (for ongoing or follow-up assessments) indicates that intervention to improve performance is necessary.


Value-driven health care is being touted as the future model for health care in the United States.1The term value has been assigned many definitions, but within health care, it usually reflects the ratio of quality and costs (value = quality/cost). Thus, value is optimized by enhancing quality while minimizing cost. Although it was traditionally assumed that higher quality would only be possible through higher expenditures, the medical community has learned that improving the quality of care may lead to long-term control of health care costs. Health care administrators have long been attentive to measuring expenditures on care and have developed cost-accounting systems that have allowed determination of costs of procedures, drugs, and various care models. However, the health care system has only recently developed explicit measures of quality. By measuring this missing piece of the value equation, it is now possible to achieve a more balanced perspective on health system performance.

The Changing ...

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