How is this measured?
The medical practice and hospital quality measures are part of the Washington State Common Measures which are being used by many organizations to chart the progress toward healthier, better lives for Washingtonians. For descriptions of the individual quality measures, see the WA-APCD measures list.
Medical Practices
The medical practice quality measure ratings compare a primary care practice’s quality to all primary care practices statewide. For each measure, one of three quality performance results are reported: Better – Average – Worse
“Better” means the practice had higher quality results compared to the average statewide. “Average“ means the practice had typical quality results compared to all practices. “Worse” means the practice had lower quality results compared to the average statewide.
Up to twenty quality measures are reported though medical practices may not have results for all measures if they had too few patients for a quality topic or for other reasons. Quality results are reported for medical practices with four or more doctors or other practitioners and only for practices that had at least four reportable measures.
Medical practice quality is scored by combining records across all of the practice’s primary care practitioners for patients with particular health problems or needs. First, patients are matched to a primary care medical practice based on their treating practitioner. Then, the patient records for all of the primary care practitioners at a practice are organized together. For each quality measure, the relevant patients are identified and the records are checked to see if the patient got the recommended care.
Quality performance is rated separately for patients with commercial health insurance versus patients with Medicaid coverage. The measures are scored using claims records for people who got care during the most recent year available. The claims are supplied by all the insurers in Washington that provide health insurance coverage in the state, for about four million people, many of whom buy insurance through their job and others who are covered by the state Medicaid Apple Health program.
The hospital quality measures compare hospitals to national standards for recommended care. The measures generally apply broadly, to many hospital patients, regardless of their treatment. For some measures a lower rate is better – like how often patients have to return to the hospital. For other measures a higher rate is better – like avoiding falls when patients are in the hospital.
Hospital quality is scored by combining records for patients who had a hospital stay or patients who got a particular type of care, like surgery. First, patients are matched to the hospital based on having an overnight stay there. Then, for each quality measure, the hospital’s patient records are used to identify the relevant patients; the records are checked to see if the patient had a good treatment result or got the recommended care. And, several measures report on the number of patients who had a positive experience using results from patient surveys sponsored by the federal government each year.
Up to ten quality measures are reported though a hospital may not have results for all measures if it had too few patients for a quality topic or does not provide a particular service. Quality results are reported for acute care hospitals; not for psychiatric, children’s or other specialty hospitals.
A number of organizations scored various hospital quality measures including several government agencies (Washington Department of Health, Washington Department of Social and Human Services, Washington Health Care Authority, and the federal Centers for Medicare and Medicaid Services) along with the Washington State Hospital Association. Certain measures are based on patients across all insurance programs – Medicare, commercial, Medicaid; other measures include Medicare patients only. The quality results mainly are based on patients who got care during 2015 and 2016.