Clinical performance: are you measuring up?

As technology enables us to gain deeper insights into clinical performance, performance metrics are increasingly being leveraged as part of a wider effort to improve health care. In this article, we take a look at how clinical performance measures play a key role in improving health outcomes.

Why is clinical performance measurement important?

Performance measurement has become one of the foundational parameters used to help improve health care quality, and has successfully improved health outcomes in many settings.

According to the Australian Medical Association, it is incumbent on all medical practitioners to improve the standard of their care, to improve the quality of their medical services, to practice medicine safely and effectively, and to participate in systems of quality assurance and improvement.

“Improving patient health status is the primary goal of healthcare and quality in healthcare is ultimately reflected in patient outcomes, with health outcomes measurements becoming an important part of assessing the quality of health care.” it stated. “And outcome measures are vital tools for medical practitioners to assess the effectiveness of a clinical intervention and standardised measures are the basis on which best practice is determined.”

And there are a number of benefits to measuring clinical performance, including that health outcomes could improve if we set standards for clinical processes – and monitor performance against those standards.

“Medical practitioners use outcome measures intrinsically to assess when treatment should be changed, referred to another, or discontinued,” the AMA added. “While outcomes may not be the only measure of quality they by and large provide the ultimate validation of the effectiveness and quality of medical care.”

One recent example is a clinical performance study published earlier this year by the American College of Cardiology, which was integral to developing the new American Heart Association (AHA) Clinical Performance and Quality Measures for Cardiac Rehabilitation (CR).

How can we best measure clinical performance?

In order to best measure clinical performance and leverage the metrics to improve patient health outcomes, experts stress it’s important to prioritise following guidelines that are likely to yield a large clinical benefit, compared with guidelines likely to yield at, best a small clinical benefit. It’s also important to remember good performance is not necessarily good care, and not to get too distracted by the pressure of improving performance to the sacrifice of offering good, patient-centric care.

“Practical and well-designed outcome measures are fundamental to understanding the benefits and value of specific actions or interventions, and for self-directed learning for continuous improvement in the delivery of and quality of care provided,” the AMA stated.

“To be meaningful, the right measure for the right purpose must be selected, and quality measures should reflect meaningful health outcomes.”

“The purpose of measuring outcomes is an important consideration in their design, their relevance, and thus their value.”

According to the AMA, in order to optimise the performance of the health system, any framework for measuring outcomes should simultaneously pursue three interdependent objectives, known as the ‘Triple Aim’: population health; experience of care; and per capita cost.

“Outcome measures are a key component of any objective assessment of the benefit or value to patients of a clinical practice or process,” it stated. “They are a tool with which any participating general practitioner and general practice can review the benefits of the services provided, and the manner in which they are provided, in order to ensure continuous improvement in patient health care and better health outcomes for their patients.”

For the purposes of leveraging performance metrics to best enable better health outcomes, the AMA also stressed the use of outcome measures within general practice must be entirely voluntary, non-punitive, and facilitated through the internal review and effective analysis of practice-held data.