The Science Journal of the American Association for Respiratory Care

1996 OPEN FORUM Abstracts

Developing Respiratory Care Quality Indicators

John S. Sabo, MS, RRT Tuesday, November 5, 1996


APPROPRIATENESS, EFFECTIVENESS, AND EFFICIENCY Reengineering the health care system will require validation of appropriateness, effectiveness, (quality) and efficiency (cost) of the changes. The method used to evaluate these outcomes will include the formation of value indicators, benchmarking, and outcomes research. The coordination of patient intervention will be performed by structured care-management programs. Under- standing how reengineering, outcomes measurement, and care-man- agement programs interact with respiratory care is essential for our profession.

THE VALUE EQUATION and BENCHMARKING Documentation of valued outcomes will be mandated by accrediting agencies (JCAHO), payers (managed care organizations (MCO), and providers (integrated delivery systems (IDS). While the 1970's and 80's advocated quality regardless of cost, the change agents of the 1990's often promote decreased cost without regard to quality. Cost and quality must always be considered in tandem as value. The value (V) of healthcare delivery equates to the high- est quality (Q) at the most appropriate cost ($) {V=Q/$}. Value Indicators (VI's) will measure the performance value of an organization's work unit or profession's processes, procedures, products, and services.

Benchmarking, the comparison of these value indicators with high- performing organizations, will be performed by providers, payers, and consumers. The goal of benchmarking is to identify outstanding performance regarding cost effectiveness, quality of life, and best practices in relation to patient interventions. Selection of value indicators is an essential part of measuring and evaluating both cost and quality aspects of aspects of service, and these value indicators must be pertinent and representative of optimal performance of patient interventions.

THE QUALITY NUMERATOR IN THE EQUATION Adverse events and non-quality work cause decreased value by in- creasing costs. Health care systems will focus on quality in order to reduce costs associated with poor quality. The improvement of quality is accomplished by identifying an expected outcome, determining the process, measuring the outcome, and acting on the measurement. Quality measures for respiratory care should be related to the areas of service, quality of life, outcomes of interventions.

THE FINANCIAL DENOMINATOR IN THE EQUATION The components that affect this factor of value are productivity, time, and fiscal performance management.

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