Evaluating the Quality of Health Care

6. Process Measures

Process measures attempt to answer the question ”Did this patient receive the right care,” or “what percent of the time did patients of this type receive the right care?” Such measures are typically developed based on the known relationship between a process and outcomes. For example if one was examining the quality of care received by a patient with diabetes, one might assess whether the patient had undergone an annual funduscopic examination by an ophthalmologist or whether the patient's feet were professionally examined annually (Brook, et al., 1996). Such measures are used because research has demonstrated a link between those processes and important outcomes, such as retinopathy or foot amputations. A nurse or medical-record technician trained in quality assessment could compare what was done to what should have been done, and the result would be expressed as the proportion of times that the criteria were met.

Such measures or criteria are typically developed by first identifying the condition of interest, and then synthesizing research evidence to create evidence-based guidelines for clinical care. Once one has identified the part of the medical care process that will be used, one defines patients who are eligible to receive care on the basis of guideline, create criterion to determine which patients received care in accordance with guideline, and divide number who received care in compliance with guideline by number of patients eligible to receive care.