Process, In-Process, and Outcome Measures – Background for ToC
http://www.google.com/#hl=en&q=process+measures&tbs=dfn:1&tbo=u&sa=X&ei=pswt
TvH7HsbkiAK_qJGwAg&sqi=2&ved=0CBwQkQ4&bav=on.2,or.r_gc.r_pw.&fp=8a58e935
55963d21&biw=1018&bih=422 downloaded July 25, 2011
 Process Measures: Healthcare quality indicators related to the methods
and procedures that a managed care organization and its providers use to
furnish care.www.youreasyinsurance.com/glossaryPage.html downloaded
July 25, 2011. Process measure can be isolated to a particular activity.
That makes them much easier to use than outcomes measures. Using
several well-selected process measures can help zero in on the goal.
 Outcomes measures: Results (of many processes) – measures of how
close you are to attaining the goal of the effort. Or there may be a specific
clinical measure such as Hemaglobin a1C, a clinical laboratory test used to
monitor control or progression of diabetes.
Additional Search Results:
Comparative process definitions
o
Process measure: a measure which focuses on a process that leads to a certain
outcome, meaning a scientific basis exists for believing that the process, when
executed well, will increase the probability of achieving a desired outcome. ...
www.scbch.org/links/glossary-of-medical-terms/ downloaded July 25, 2011
o
Process Measure: A measure of a business process that demonstrates where
value is being delivered to a stakeholder. www.processexecutive.com/blog/bpmguide/glossary/ downloaded July 25, 2011
Outcome Measures and Output Measures Illustrated
http://curiouscat.com/management/outcomemeasures.cfm
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Outcome Measures description - a measure of the result of a system, relative to
the aim. An outcome measure is used to measure the success of a system. For
example, the outcome measure could be the percentage of people who do not
get polio. An output measure, for example, would be the number of people
vaccinated with the polio vaccine. Often management focuses on output
measures which do not tell you about the success but rather are a measure of
activity. Care should be taken to define good outcome measures to use in
determining the success of programs and in determining the whether
improvement projects result in improved outcomes.
Examples of outcome measures: literacy rate, infant mortality rate, days without
an accident on a job site, students finding a job they want (for a university),
tomato yield from a tomato plant, on time arrival at destination, percentage of the
population who can see (for a measure of the success of a program to eliminate
preventable blindness). Related terms:

Output Measures description - a measure of activity, for example, the number of
cars produced by an assembly line, or the amount of money spent on education,
or the number of phone call processed by a call center.
Operational Definition

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Process Measure - measures of the performance of a process. Process
measures can provide real time feedback that can be acted on quickly, when a
process first provides data that something is amiss. Of course, care must be
taken to avoid tampering.
Activity Measure - a measure of the level of resources committed to a process.
So as an example, the total amount of dollars spent to eliminate polio in the
United States would represent an activity measure (how much money was
committed to the activity). An in-process measure could be (looking at various
regions of the country possibly) a measure what percentage of potential
vaccinations that were wasted (spoiled, lost...). Another in-process measure
example could be the cost per vaccination (say $30 million dollars for to run the
whole program which results in 15 million vaccinations). From this example, an
outcome measure could be the reduction of polio in the population (for example,
.5% of the population was newly diagnosed with polio and in the first year and
the next year it was .3% and then .1%...).
An update on the polio example from a Worldwide perspective, the World Health
Organization: "targeted the year 2000 to complete the polio eradication plan. This
was not achieved due to vaccine shortages, wars, and logistical problems in
Africa and the Indian subcontinent. Nevertheless, polio will be eliminated from
190 countries by the end of this year, and WHO is optimistic that it will achieve
global eradication by the new target date of 2005." Posted 6/9/2000 on the Johns
Hopkins Infectious Diseases web site. And a site dedicated to continuously
updated statistics: polio eradication.org.
In-process Measures:
http://www.baldrige.com/criteria_informationmanagement/in-process-measures/
In-process measures track the performance of a process as it is unfolding,
providing real-time feedback that can be acted upon without waiting for the
process to end, at which point end-of-process or outcome measures tell you the
results of that process. In a perfect world, in-process measures align with end-ofprocess measures. Most of the results in Category 7 of a Baldrige application are
for end-of-process measures. The alignment allows an organization to predict
how it will perform on those end-of-process measures and fix problems during
the process to get better results. This type of measure has the intrinsic and
explicit requirement that the process measures selected for monitoring be part of
the same process that leads to the outcome.
Measure Type Definition Illustration:
http://www.health.state.mn.us/healthreform/baskets/measurement090609_definition.pdf
Donabedian’s structure-process-outcome model is a useful framework for
quality assessment and illustrates
the link between process and outcome:
“Before (quality) assessment can begin we must decide how quality is to be
defined and
that depends on whether one assesses only the performance of practitioners or
also the
contributions of patients and of the health care system. (To adequately assess
quality of
health care) we also need detailed information about the causal linkages among
the
structural attributes of the settings in which care occurs, the processes of care,
and the
outcomes of care.” (Donabedian, JAMA, Vol. 260 No. 12, September 23, 1988)
Structural measures – measures of organizational characteristics (such as
staffing ratios, number of hospital
beds)
Process measures – interactions between healthcare practitioner and patient; a
series of actions, changes, or
functions bringing about a result (such as mammography screening rate)
Outcome – changes (desirable and undesirable) in individuals and populations
that are attributed to
healthcare. There are a variety of outcome measures and ways to label them,
e.g. Those representing an end result
(such as mortality or function)

Intermediate outcomes (physiologic or biochemical values – like blood
pressure or LDL value).
 These precede and may lead to longer-range end result outcomes.

Proxies used to indicate an outcome – (such as hospital readmission
indicates deterioration in health
 status since discharge). These can be the same as process measures.
Type of Outcome Example
 Healthcare acquired adverse event - Surgical site infection
 Patient function - Performance of activities of daily living
 Mortality - ICU mortality

Intermediate clinical outcome - Improvement in blood pressure/
 Blood pressure under control
 Service utilization as proxy for pt outcome - Return to higher level of care
(ICU)
 Morbidity related to disease control - Blindness related to diabetes
 Health related quality of life - Social role and mental capacity
http://curiouscat.com/management/outcomemeasures.cfm
Outcome Measures - a measure of the result of a system, relative to the aim. An
outcome measure is used to measure the success of a system. For example, the
outcome measure could be the percentage of people who do not get polio.
Using the measure types:
http://intqhc.oxfordjournals.org/content/13/6/475.full.pdf
See the full article.
http://management.curiouscatblog.net/2008/07/14/outcome-and-process-measures/
You should have all these types of measures but outcome measures are most
likely to be missing so special care should be taken to make sure you are using
them. It is important to define good outcome measures to use in determining the
success of systems, and in determining the whether improvement projects
actually result in improved outcomes.
In-process measures can be valuable in providing actionable information sooner
than the outcome measure would allow action. In the polio example, an in
process measure example could be % of vaccination by the time a babies is 18
months old. And looking across a country say it might well make sense to stratify
the data to see if certain areas were doing poorly on this measure. If so that
might be where to focus improvement. You don’t need to wait until people not
vaccinated start contracting polio (which will likely be delayed for years after the
system starts to have processes fail, in this example) to then notice the problem
and then react.
Waiting for the outcome measure to point to a problem in this case (and in many
cases) is far too late for process improvement. So process measures are needed
to aid in managing the system and reacting to process results, before those
processes create poor results (and can be seen as poor outcome measures).
ToC project:
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In-process measures may be useful for software development.
Process measures and outcomes measures are more likely to be useful for
public dissemination of information. The main reason is that we are limited to
indicators, so we will be providing highlights of processes that are well-chosen
rather than details of processes themselves.