Structure measures evaluate the infrastructure of health care settings, such as hospitals or doctor offices, and whether those health care settings are able to deliver care. These measures include the staffing of facilities and the capabilities of these staff, the policy environment in which care is delivered, and the availability of resources within an institution.
Structure measures are often used by insurance companies and regulators to determine whether a provider has certain capacities needed to deliver high-quality care, such as whether a hospital has a system in place to order prescription drugs electronically. These measures are also commonly used in the certification or accreditation of health plans and providers.
Two key reasons for using structure measures are that characteristics of health care settings can significantly affect the quality of care, and care settings that meet certain standards have an advantage when it comes to providing high-quality care.
Although structure measures provide essential information about a provider’s capacity, it is important to note the limitations of these measures. In particular, structure measures provide just one piece of the full picture of care. For example, the fact that a hospital has the ability to perform certain functions does not capture whether or not these functions actually occur, nor does it capture whether those functions improve patient health. In short, the fact that a health care provider or facility meets the requirements of a structure measure may not result in that provider delivering care that improves patient health. For example, some forms of provider accreditation and certification require providers to use electronic health records. A provider could buy an electronic health record system but continue to rely on paper records and still meet this structural requirement.
As part of the general information available through CMS, structural measures reflect the environment in which providers care for patients. Examples of structural measures can be inpatient (participation in general surgery registry) or outpatient (tracking clinical results between visits). Hospitals submit structural measure data using an online data entry tool made available to hospitals and their vendors. Structural measures include information provided by the American College of Surgeons (ACS), the Society of Thoracic Surgeons (STS), the Joint Commission (TJC), and CMS.