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

Miller maryland hospital association personal

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Unformatted text preview: indicators for hospitals and practices in those states (B. Miller, Maryland Hospital Association, personal communication). In the US, where employer-provided health insurance is the norm, consortia of employers are also using quality measures to assess and select providers, and these are also beginning to incorporate some evidence-based measures of structure and process. Whereas the first effort of this type, the Cleveland Health Quality Choice program [15], focused on outcome measures, newer efforts are now including evidence-based, validated structure and process measures. For example, The Leapfrog group [16], a health care purchasing consortium representing Fortune 500 companies, has developed a national measure of quality of intensive care unit (ICU) care and provides incentives for their employees to purchase health care from hospitals that meet this standard. In the area of validated structural and process measures, the standard includes whether intensive care spets are monitoring the ICU, which has been demonstrated to improve patient outcomes [17]. Health care quality measures, including process measures, are developed for varied audiences who may wish to use them for health care purchasing, utilization, or performance improvement. For all these purposes it is imperative that they are meaningful, scientifically sound, generalizable, and interpretable [18]. To achieve this, quality measures must be designed and implemented with scientific rigor. In this essay, we present an overview of the advantages and disadvantages of using process measures as quality of care measures, and 470 discuss practical strategies for using quality measures for improvement. Advantages and disadvantages of process measures of quality of care There is considerable debate regarding whether quality measures should evaluate processes or outcomes of care. Before proceeding to develop process indicators, those considering this may find it useful to understand their strengths and limitations. Within the categories of process and outcome, there are good and bad measures, but some specific advantages and disadvantages a...
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