Domains of Quality: Efficient

The Institute of Medicine (IOM) considers efficiency to be one of the six domains of healthcare quality. Efficiency can be defined as avoiding waste, so measures of overuse of healthcare services are a measure of efficiency.

HEDIS has developed four overuse measures that are included in the OPA Report Card; inappropriate use of antibiotics for bronchitis, inappropriate use of antibiotics for children with an upper respiratory infection (URI), inappropriate use of antibiotics for children with pharyngitis (throat infection), and unnecessary x-rays for members with low back pain. However, apart from these examples, there is little information available on efficiency through HEDIS.

Another way to conceptualize efficiency is as the cost of providing quality healthcare. This often means measuring utilization of healthcare services. Many organizations including NCQA nationally and Integrated Healthcare Associates in California are attempting to define measures of efficiency that include assessing the utilization of healthcare services as well as the quality of care. This topic is also of interest to policy makers and to HMOs themselves as they look for ways to provide high quality services at the lowest price.

One measure of efficiency is whether individual HMOs or particular types of health insurance do a good job of keeping patients with chronic conditions such as asthma healthy and out of the hospital. This is a measure of efficiency because it is less expensive to take care of patients in ambulatory settings such as clinics and doctors offices than it is to take care of them when they are sick in the hospital, and high quality care in ambulatory settings can keep patients with chronic conditions such as asthma out of the hospital. AHRQ calls these types of hospitalizations “preventable hospitalizations”. They are also sometimes called “ambulatory care sensitive conditions”. Higher rates of "preventable hospitalizations" may pinpoint areas in which potential improvements can be made in the quality of the U.S. health care system. Visit the AHRQ site for more information on preventable hospitalizations.

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