What are Quality Gaps?
Quality gaps are discrepancies between the standard of care and how patients receive care. They can be measured through direct observation, patient surveys, or clinical audits. Quality gaps are a measure of the difference between what is being delivered and what is expected from health care. The size of a quality gap varies depending on the quality metric used. For example, the closing gaps in care for a pneumonia diagnosis can be defined as how many patients were not diagnosed with pneumonia.
These quality gaps could only be discovered by reviewing medical records, but with the development of technology, these gaps are now being captured electronically.
With Quality Gaps, payer quality gap data is easily and seamlessly connected to provider EHRs for improved gap closure performance at the point of care.
The gap in care is an important indicator of a system’s ability to provide the standard of care. In this case, the standard of care would be to diagnose a patient with pneumonia. The gap, or difference, between the standard of care and the care that is delivered to patients is the number of patients who are not diagnosed with pneumonia. The gap can also be expressed as the percent of patients with pneumonia that are not diagnosed.
As I have noted before, the quality metric could be expressed as a percentage or as a number. Quality gaps are not new. There is evidence that quality gaps have been identified and documented for years. Quality gaps are not new to healthcare as a whole and certainly are not new to payers. They exist in every hospital setting in the United States.
Take the case of an acute care hospital where patients receive a diagnosis of pneumonia based on a physical exam. Quality metrics are used to measure the difference between what is expected and what is delivered. These quality metrics could be measured using direct observation, patient surveys, clinical audits, or any other method. In order to close these quality gaps, a number of methods can be used, depending on the quality metric being measured.
The purpose of quality gaps is to identify what is not being done and how it is impacting patient outcomes. Quality gaps are not a bad thing; they are merely a reflection of the standard of care. In the case of pneumonia, patients diagnosed with pneumonia represent the standard of care. The quality gap represents the difference between the standard of care and the care that was delivered. This difference is the gap. The gap can be expressed as a percentage or as a number. For example, in the case of a pneumonia diagnosis, a quality gap could be the number of patients who were not diagnosed with pneumonia.