When we think about measuring performance in health care, measures are often grouped into some common domains. There are several major domains of performance measurement that are common among existing measurement systems. I'm going to review these common domains with you and provide some examples of measures from each of these domains. First domain that we often use for performance measures is this idea of patient safety. And for each of the domains, I've actually provided a definition. Those definitions come from a variety of sources. For patient safety, I liked this definition of patient safety, which is "freedom from harm." The Leapfrog Group has a hospital safety great expert panel, and this is the definition that they have used for patient safety to guide their work. Some examples of performance measures that would fall into a patient safety domain would be things such as the percentage of surgical cases that had an object left in after surgery, rates of hospital-acquired infections, and the percentage of medication administrations in which both the patient and the medication were scanned prior to administration. When we think of patient safety, we're thinking of errors, we're thinking of injuries, and we're thinking of accidents. Another domain for performance measures would be quality. And I see quality as a broader context or domain than patient safety. I see patient safety as being fairly narrow. I see quality being a broader construct. The Institute of Medicine, their definition of quality is, the degree to which health care services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge. Some examples of quality measures would include things such as hospital-level mortality rates, complication rates after a patient has total knee replacement surgery, and a hospital's preterm birth rate. Another domain would be resource use. The Agency for Healthcare Research and Quality, their definition of resource use is "reflects the amount or cost of resources used to create a specific product of the healthcare system." Some examples of performance measures of resource use would include things such as the average length of stay of a patient in the hospital, the average cost per discharge, and a cost per episode of care, which would include all the services related to a particular medical condition, or acute care of it. Another domain of performance measures is this idea of value. I took this definition of value from Michael Porter who is a professor at the Harvard Business School. His definition of value is "health outcomes achieved per dollar spent." And while I don't have any concrete examples of value measures to share with you, I do want to further clarify what a value measure would look like. Typically, it's a blended measure of quality of care and resource use. So, in the previous two slides, we talked about measures of quality, and we talked about measures of resource use. A measure of value is one that would bring those two concepts together. In a measure of value, quality is typically the numerator of the measure and cost is the denominator. And the way you achieve higher value is either by increasing quality, increasing your numerator, decreasing cost, which would be decreasing your denominator, or some assessment of both. Another domain of performance measurement is patient satisfaction. And this would be the extent to which a patient is content with the health care that they received from their health care provider. Some examples of performance measures of patient satisfaction include the quality and temperatures of meals served in the hospital, wait times to see the doctor, and the courtesy of office staff. The final domain of performance measurement that I'd like to offer you is patient experience. And The Beryl Institute, their definition of patient experience is "the sum of all interactions, shaped by an organization's culture, that influence patient perceptions across the continuum of care." Some key examples of measures of patient experience include that the staff explained the medicines to the patient before giving the patient the medication, the provider explained things in a way that was easy for the patient to understand, and that someone from the provider's office followed up with the patient to give the results of a blood test, an x-ray, or some other test.