A performance measurement system is defined by the Joint Commission as a system composed of:
- a set of process and/or outcome measures of performance,
processes for collecting, analyzing and disseminating these measures from multiple organizations, and
- an automated database which, together, can be used to facilitate performance improvement in health care organizations.
A measurement system must be able to generate both internal comparisons of each participating organization's performance over time, and external comparisons of performance among participating organizations.
Performance measures-quantitative measures used to evaluate and improve outcomes or the performance of functions and processes-are incorporated into the Joint Commission's accreditation process as part of the ORYX™ initiative. The goal of ORYX is to create a more continuous, data-driven, comprehensive and valuable accreditation process-one that not only evaluates a health care organization's methods of standards compliance, but the outcomes of these methods as well.
Performance measures are essential to the credibility of any modern evaluation activity for health care organizations. They supplement and guide the standards-based survey process by providing a more targeted basis for the regular accreditation survey; a basis for continuously monitoring performance; and a basis for guiding and stimulating continuous improvement in health care organizations.
Choosing performance measurement systems
In 1995, the Joint Commission presented to accredited health care organizations a list of measurement systems from which they could choose a system or systems to meet the requirements of the ORYX initiative. In the initial phase of ORYX, an organization may select the system(s) that best meets its overall measurement needs, and from the system(s), choose those performance measures that are most applicable to the patient care services it provides. As of June 2001, 197 performance measurement systems meet the screening criteria to be on the list.
As outlined in the ORYX initiative, some organizations seeking accreditation will be expected to participate in one or more of these listed measurement systems. Health care organizations are to submit data through the measurement system at regular intervals to the Joint Commission, which in turn will use this information in the survey and accreditation process. After common national measures-core measures-for various types of organizations and services are identified and embedded in the listed systems, the measures each health care organization submits to the Joint Commission through the chosen measurement system will be standardized across systems.
In early 1999, the Joint Commission solicited input from a wide variety of stakeholders-clinical professionals, health care provider organizations, health care consumers, and performance measurement experts-about potential focus areas for these core measures. In 2000, the Joint Commission identified the four initial core measurement areas for hospitals: acute myocardial infarction, heart failure, community-acquired pneumonia, and pregnancy and related conditions. Hospitals will begin collecting core measure data for patient discharges beginning July 1, 2002. For more information on core measures see Facts about Core Measures.
The Advisory Council on Performance Measurement
The Joint Commission's Advisory Council on Performance Measurement reviews measurement systems against an established set of criteria. A measurement system must meet all the criteria in effect in order to continue to be listed. The Advisory Council, comprised of nationally known experts in outcomes measurement appointed by the Joint Commission's Board of Commissioners, established an evaluation framework and criteria that are used to review applicant performance measurement systems. The framework incorporates seven broad characteristics, or attributes of conformance, and identifies specific criteria relating to each attribute. The attributes are:
- performance measure characteristics
- database (measurement system technical capabilities)
- performance measure accuracy
- risk adjustment/stratification
- performance measure-related feedback
- relevance for accreditation
- technical reporting requirements
No system can be used to meet accreditation requirements until it has signed a contract with the Joint Commission and the Board of Commissioners has acted to list it.
For More Information
If you have additional questions, please call the ORYX Information Line at (630) 792-5085, or submit questions via e-mail to oryx@jointcommission.org.