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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 , focused
on outcome measures, newer efforts are now including
evidence-based, validated structure and process measures. For
example, The Leapfrog group , 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 .
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 . 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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- Spring '09