Int J Qual Health Care-2001-Rubin-469-74

Measures of the process of care that affect outcomes

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Unformatted text preview: cardiac surgery by hospital and surgeon [9–12]. Measures of the process of care that affect outcomes were initially considered too technical for public or regulatory use. Address reprint requests to H. R. Rubin, Quality of Care Research, The Johns Hopkins University, 1830 East Monument Street #8015, Baltimore, MD 21205, USA. E-mail: hrubin@jhmi.edu 2001 International Society for Quality in Health Care and Oxford University Press 469 H. R. Rubin et al. Theoretically, providers would respond to publicly reported outcome measurement by developing and implementing their own internal report cards focused on evidence-based process measures. However, given the complexity and expense of developing clinical guidelines and process measures and keeping them updated, and the infancy of clinical information systems that would track the clinical process routinely, individual provider organizations have had difficulty incorporating process measurement into their operations. In the last five years, joint efforts by providers, professional societies, monitoring agencies, and quality-of-care experts have begun to assist in identifying and implementing appropriate process-of-care measures. In addition, government and payers have a better understanding of the difficulty of risk-adjustment for outcome measures such as mortality rates, and their own interest in process of care measures of quality has grown. The National Committee on Quality Assurance (NCQA) in the United States collects data on HEDIS quality measures and includes evidence-based measures of health plan processes of care [13]. In the US, these measures are part of NCQA’s health plan accreditation program and are used by some employers, insurers, and government payers to choose participating health plans. CMS (formerly HCFA) in the US has also proceeded from reporting on Medicare beneficiary mortality rates to developing, measuring, and reporting on evidence-based hospital and outpatient care processes [14]. Although HCFA has released data on indicator performance to the public only by state and not by provider, several US states have passed or are considering legislation to collect and publish the same...
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