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Unformatted text preview: ss. Thus, use of certain processes as indicators of care
may be dictated by availability of data, rather than the relative
importance of the element of care. In addition, a provider
may adhere well to one part of the process but not to another.
Therefore, if process measures are not comprehensive and
do not cover all the important parts of the process that can
affect outcomes, they may be misleading to users. Practical strategies for developing quality
As we have discussed previously, the audience for and use
of the quality measure will inﬂuence how the measure is
developed and how the results are presented. Quality measures
are in general used by provider or care management organizations to evaluate and enhance performance through
quality improvement initiatives, by purchasers and patients
to inform health care decision making, or by accreditors and
regulators to monitor organizations.
Internal quality improvement initiatives
For internal organizational quality improvement initiatives,
more detailed, less aggregated measures of quality may be
more helpful than summary measures. Providers want information regarding how to improve speciﬁc processes. As
such, the unit of analysis for these initiatives tends to be
small, such as the individual unit, practice, or clinician. These
types of measure often require signiﬁcant technical detail. An
important consideration in these types of measure is that
clinicians believe that the process is related to the outcome
such that improvement in the process will result in improvement in outcomes. Without this belief, it is often
necessary to establish the link between process and outcome.
Data collection for quality improvement can be made part
of routine care by existing staff and thus marginal costs
are minimal. Electronic medical record systems play a very
important role here, and whenever possible, quality assessment efforts should attempt to obtain needed data by replacing usual clinical data collection with collection of
standardized data elements. Finally, when used internally for
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- Spring '09