JAMA editorial: Measure more processes to improve care
A study of quality process measures for acute myocardial infarction (AMI) found that their application accounted for only 6% of hospital-level variation in risk-standardized, 30-day mortality rates for patients with AMI. The study, published in the July 5 issue of the Journal of the American Medical Association (JAMA), demonstrates the need for "multiple measures that reflect a variety of processes and also outcomes, such as risk-standardized mortality rates," to more fully capture hospital performance.
The findings of the study, "Hospital Quality for Acute Myocardial Infarction: Correlation Among Process Measures and Relationship With Short-term Mortality," show several shortcomings in how organizations such as the Centers for Medicare & Medicaid Services and the Joint Commission on Accreditation of Healthcare Organizations measure quality, according to an editorial published in the same issue of JAMA.
"Although the current process measures are a good start, they are too few in number and only capture a small subset of clinical care," writes Ashish K. Jha, MD, MPH, of the Harvard School of Public Health. "...[A] greater breadth and depth of process measures are needed and should capture patients admitted for other clinical conditions, such as gastrointestinal diseases, renal disease, and many other conditions."
The author writes that measuring outcomes as well as processes is important to improving quality of care, but notes the need for other outcome measures beyond mortality, such as patient experience, hospital efficiency, and equity of care. Jha notes that databases such as the National Registry of Myocardial Infarction (NRMI) are crucial for advancing quality measurement and improvement.
Sources:
"Measuring Hospital Quality: What Physicians Do? How Patients Fare? Or Both?" JAMA. 2006; 296: 95-97.
"Hospital Quality for Acute Myocardial Infarction: Correlation Among Process Measures and Relationship With Short-term Mortality." JAMA. 2006; 296: 72-78.