Performance measures in health care: new report from RAND


An independent evaluation of the use of performance measures for accountability and quality improvement from RAND Corporation reports on how these are being used by a wide array of organizations in the USA. The availability of data from which to construct measures was the single most important factor cited as either facilitating or impeding their use.


Over the past 20 years a wide array of standardized health-care performance measures have been developed. Quality and efficiency measures are embedded throughout the U.S. health-care system. However, there has been no systematic attempt to document how they are being used and what opportunities exist for enhancing the end users’ ability to use such measures to achieve their objectives.

Study questions

  • How are performance measures being used in practice?
  • What factors are influencing the use of measures?
  • What types of system changes have occurred as a result of their use?
  • What could facilitate the use of standardized endorsed performance measures?

Study design

RAND selected a purposive sample of organizations from 11 different categories and collected data via (1) interviews with key informants (n = 30 end-user organizations) and (2) reviewing publicly available documents and materials from websites (n = 70 end-user organizations).

The use of performance measures was categorised by four purposes:  Quality improvement; public reporting; accreditation/ certification;  payment applications

Key findings

Use of performance measures

  • Many organizations use measures for multiple purposes – and public reporting (64%) and Quality Improvement (69%) were the most commonly reported uses
  • End users reported using measures drawn from seven core measurement domains: structure, process, outcome, access, safety, costs, and patient experience.
  • Process of care measures are the most common type of measure being used (83%)

Factors influencing measure use

The single most important factor cited as either facilitating or impeding the use of measures was the availability of data to construct performance measures.

  • Factors facilitating their use include a strong data infrastructure; provider trust in the process and the evidence base of the measures; alignment of measures among reporting requirements to minimize reporting burden; relevance; provider training
  • Factors impeding their use include the burden of reporting (lack of prioritization of measures; “measure fatigue”); cost; lack of timely data; the challenge of reliably measuring the performance of individual physicians and small physician

System changes resulting from measure use

Few interviewees reported that they had performed formal studies to document results.  Several organizations noted that:

  • they were just starting to evaluate the impact of their measurement activities.
  • publicly reporting performance had had little effect on consumer behaviour
  • public reporting of measures has influenced provider behaviour

The paper concludes with recommendations for improving the uptake of standardized measures, including the provision of a clearinghouse for Quality Improvement measures, and future opportunities to support the use of measures.

Evaluation of the Use of Performance Measures in Health Care by Cheryl L. Damberg et al., 2011

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