Review of Process Measures – Accountability

After introducing the 5 Performance Measures for value based payments, I thought maybe we should dig a little deeper into each one. It has been a few weeks and hopefully you have had time to evaluate or create a plan for Process Measures.


Accountability – demonstrates Structural Measures. Measuring the conditions in which care is provided.


As defined by the Agency for Healthcare Research and Quality, Structural Measures assess features of service delivery at your organization, as well as, the capabilities of your staff and the policy environment in which care is delivered. 


Foundation, Structure, Attribute or the ‘set of standard’ aspects that impact how day to day services are delivered to your consumers is how you can think of a Structural Measure. Sometimes confused with Process Measures, a good way to distinguish between the two is, a capability or asset (structural) and the activity that may rely on the structure (process). They are usually incorporated into quality assurance procedures that set a standard of practice and are assessed for accreditation.


How do Structural Measure contribute to our organization’s performance?  They are quite literally the foundational assets to consumer outcomes.  For example, your I/DD consumer has achieved the outcome of using a tablet to communicate spoke words via an application (outcomes measure) when a caregiver spent 10 hours a week for 24 weeks teaching them how it works and celebrating milestones to keep encouraging success (process measure), after the caregiver received installation and training on how to utilize the application with consumers (structural measure).


Here are the questions provided by AHRQ to consider when selecting a Measure of Structure.

  1. Is there a strong link between the measured structural feature and the processes and outcomes of care?
  2.  Are there intermediate factors that mediate the association between the structural feature and associated processes or outcomes of care?
  3. Is the measured structural characteristic modifiable by the organization, professionals, or other staff?


The use of OnTarget (electronic health records) to capture aspects of care and associate them with process and outcomes is a Structural Measure. If you are evaluating or plan to evaluate for a performance driven solution give us a call to include OnTarget in your project.