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Unformatted text preview: r faulty process; benchmarking is
needed for comparisons among groups
and adjusted outcomes can be difﬁcult
to understand 471 H. R. Rubin et al. Thirdly, process measures can usually be collected more
quickly than outcome data for two reasons, Firstly, outcome
events may be rare where only a small percentage of the
patients have the outcome, requiring one to accrue a larger
sample of patients. In addition, many outcomes that are
important to patients, such as quality of life and functional
status, may require years after the illness to evaluate, increasing
the time for measurement. In contrast, care delivery occurs
in a shorter period of time, and every eligible patient receives
the speciﬁc process of care being evaluated.
On the other hand, there are several disadvantages to
process measures. Firstly, to be valid, there must be a strong
relationship between the process and outcome measures.
These links between process and outcomes can come from
previously published evidence, or may be demonstrated for
the group whose quality of care is being evaluated. The prior
evidence supporting the relationship may be weak or nonexistent for many processes even when they are truly linked
to outcomes. Even when studies have been carried out, they
may not demonstrate true process–outcome linkages. For
example, observational studies may show paradoxical associations of good care with inferior outcomes because of
confounding by indication. In confounding by indication,
sicker patients (who subsequently have worse outcomes)
receive more or better care, setting up the paradoxical observation that good care is linked to inferior outcomes. This
phenomenon is particularly problematic for patients with
chronic illnesses such as asthma, for which measures of
intrinsic disease severity are poor. Therefore, it may be
difﬁcult to ﬁnd evidence to support valid process measures.
Secondly, when evidence linking process and outcomes is
absent yet providers believe the process is important, or
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This document was uploaded on 03/09/2014 for the course ACC 301 at HELP University.
- Spring '09