Measurement: Process and Outcome Indicators
Methods of Quality Improvement
Things Quality Improvement is NOT
Summative Experience

Proxy Measures

Many Healthcare issues are very complex. Think about the prevention of heart disease. The goal is to reduce morbidity and mortality. The disease process is very slow—it would take decades to show up. What can you measure in a timely fashion?

This leads to the concept of proxy measures. Using a proxy measure means when you can’t measure exactly what you want/need, you measure what you can.

  • Sometimes you have to use a process measure instead of an outcome
  • Or you use a measurable process in place of one that is tougher to get at

For example, you may be interested in how effective the members of your practice are in counseling for smoking cessation. Since details of that are embedded in free text in medical records, to enable you to make use of computer records you may choose instead to look at:

  • How many patients had “tobacco abuse” coded as a diagnosis
  • How many received prescriptions for Zyban or nicotine replacement

While these clearly do not represent exactly what you want to look at, the presence of either does suggest that smoking cessation counseling did occur.

Proxy measures:

  • Are used when you can’t exactly measure what you want or need
  • Measure something that is close enough to reflect similarly

Can you think of proxy measures that might be used to assess care for prevention of coronary artery disease?


These are all process measures. Since it is impossible to measure outcomes that don’t occur, we use measures of care that have been shown in other research to be effective in achieving our goal.


Index Previous Next

Questions about this website, please email: CFM_Webmaster@mc.duke.edu
© 2016 Department of Community and Family Medicine, Duke University School of Medicine. All Rights Reserved.