Process, Outcome and System Measures for Long Term Supports and Services

September 1, 2018

The aim of this white paper is to describe and promote the use of a system of integrated metrics to measure the improvement of the Long Term Care, Support & Services (LTSS) system in federal, state and local government organizations.

The purpose of such a system is to measure the overall quality, safety, effectiveness, timeliness and value of long-term supports and services to include the delivery and improvement of the care provided to citizens in government health and human care systems (GHHS) and to align improvement work across multiple processes, agencies and providers. This includes aging and disability populations who may need services and supports as citizens in the communities they reside in, as well as in long term care or congregate care facilities.

A balanced set of LTSS process, outcome and system measures, is necessary to provide GHHS leaders and other stakeholders with data that help them evaluate the overall performance of the core dimensions of quality, effectiveness and value, as well as equity. These measures serve as inputs to continual quality improvement planning as an LTSS and GHHS strategy.

Properly constructed, these system measures should be supplemented by existing measures that parts of the GHHS organization and stakeholder organizations use to evaluate the performance of their part of the LTSS system. Because they are intended to focus on important system level measures of quality, effectiveness, and value, they are limited to a small set of measures that are not person, disease, condition or program specific. Each of them should impact the outcome of the processes that deliver important services and supports to vulnerable people.

One aim for developing the LTSS system measures is to also provide a view of performance and improved productivity that reflects services provided in different programs, processes, services, and locations, no matter who does the work across the continuum of services. Improved productivity of the LTSS system of services and the interaction of its parts will result in better quality, safety, timeliness, effectiveness and value for the beneficiaries and stakeholders in the system. Please note, effectiveness is defined to include efficiency.

Effectiveness includes all of the other important dimensions of the LTSS system. “Doing the right things” is a systems view of effectiveness that includes the “doing it right” view of efficient use of resources, safety is included as helping people be and stay safe is an ethical imperative. Timeliness is also included within the definition of effectiveness and doing the right thing, and a focus on quality helps achieve the overall aim of the system. Over time LTSS systems may develop balanced system measures to predict whether sustainable value is delivered equitably to both citizen beneficiaries and citizen taxpayers, no matter where they live, or who they are.