Using Performance Measures to Track and Improve Quality of Care
Standardized performance measures within health care settings help to identify opportunities to improve patient care, reduce costs, and increase efficiency of care delivery while also allowing for monitoring of success in satisfying regulatory requirements and supporting public accountability.208, 209 These measures are increasingly emphasized as a means of promoting and ensuring quality in health systems.
This section describes the use of these measures to help identify weaknesses, prioritize opportunities, and identify what works and doesn’t work to drive quality improvement (QI) efforts in the context of SRH. Quality improvement draws on a wide range of approaches and methods, most of which share underlying principles and steps to identify the quality issue(s), understand the problem from a range of perspectives, design and plan delivery of an improvement intervention, identify and test solutions, and implement the solution and ensure the intervention becomes standard practice.
Within the context of SRH, performance measures can be embedded in a health care system’s QI process to help assess its capacity and effectiveness at meeting an individual’s SRH needs and preferences—and to identify, track, and address inequities. Such QI processes should be based on the underlying principles shared above and focus on efforts to improve access and patient-centeredness.210
The following terminology is used to define performance measures for SRH services. A performance measure is a valid and reliable measure of a health care structure, process, or outcome that captures a component of quality SRH services consistent with the definition of quality family planning and SRH and aggregated at a provider, facility, plan, state, or regional level.211
- Structure refers to the context in which care is delivered, including the physical environment, staff, financing, and equipment.
- Process refers to the transactions between patients and providers throughout the delivery of health care.
- Outcomes refer to the effects of the structure and process of health care on the health status of patients and populations and on the patient experience of care.
- Validity and Reliabilty: Validity of a performance measure refers to whether it measures what it was intended to measure. Reliability refers to whether the same results can be produced consistently under the same conditions.
Importantly, performance measures can, in some cases, adversely impact outcomes and patient experience by incentivizing specific behaviors or processes inconsistent with quality care. For example, metrics for frequency of testing for sexually transmitted infections can contribute to patients being tested without their knowledge or consent.212, 213 To protect against these effects, measures that reflect experience of care and people’s lived experience are critical. This is particularly important in SRH due to the personal nature of decisions related to reproduction, the historical and contemporary reproductive oppression and coercion in the United States, and the well-documented inequities in care by race and ethnicity.214, 215 To ensure appropriate use, performance measurement and QI processes should emphasize people’s experiences and preferences, avoid creating harm by monitoring and protecting against adverse impacts of performance measures, allow for evaluation of inequities through appropriate data stratification, and disseminate results intentionally to promote implementation of evidence-based practices and help ensure measures are being interpreted and applied in a meaningful way.215