Organizing Quality Measures by Type

The oldest categorization of health care quality measures was created by Avedis Donabedian when he distinguished between measures of structure, process, and outcome.[1] More recently, patient experience and cost measures have been added to those being considered. Many people who work in health care quality find it very easy to think about measures using these categories, but it is not clear whether they will be helpful to consumers.

Advantages of Categorizing by Type of Measure

  • It is relatively easy for report designers to sort measures into these categories.
  • If the categories are properly and clearly explained, the measures within each category will have a clear relationship to each other, and could therefore be easier to understand.

Disadvantages of Categorizing by Type of Measure

  • Consumers are unfamiliar with both these terms and the concept of measure types. Moreover, it is not clear that this model helps them understand quality measures. While it may well be possible to explain these terms, it is always better to communicate to people in something as close as possible to their language, rather than your language.
  • These categories have never been formally tested with consumers.
  • Process measures are not always correlated with outcomes, like mortality, which can create confusion.

[1] Donabedian A. Evaluating the quality of medical care. Milbank Mem Fund Q. 1966 Jul;44(3):Suppl:166-206.

Also in "Organizing Measures To Reduce Information Overload"

Page last reviewed February 2016
Page originally created February 2015
Internet Citation: Organizing Quality Measures by Type. Content last reviewed February 2016. Agency for Healthcare Research and Quality, Rockville, MD.
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