Emerging health networks are poised to play an important role in the future American health care delivery system. The trend toward vertical integration, coupled with growing purchaser and consumer demands for information about value, has created an increasingly chaotic measurement environment. This article describes a successful collaborative effort among providers, users, and purchasers of health services and developers of performance measurement tools and databases to develop principles and a framework for measuring the performance of health care networks. Eleven principles and five measurement categories were identified; seven clinical conditions were targeted for performance measurement.

Communication↗

PubMed1995

The evolution of quality measurement in surgery: from standards to indicators.

This paper illustrates the potential value of statistical profiles of important measures (indicators) of surgical quality as a tool for continuously improving surgical care. Review of the literature was used to identify indicators of surgical quality, and a review of experiences in using those indicators to evaluate the performance of hospitals and individual surgeons was conducted. Consensus of surgeons can identify important process and outcome measures of surgical quality. These measures can provide valid and reliable comparative data on hospital performance. Wide variations in hospital performance on many of these measures have been observed in US hospitals. These variations may represent opportunities for improving the quality of surgical care. Indicators of surgical quality, developed and interpreted by surgeons, can be valuable tools for identifying variation in the performance of hospitals and for improving the quality of care.

Female↗

PubMed1990

Medicare mortality rates and hospital quality: are they related?

In 1987, the Health Care Financing Administration (HCFA) compiled and released mortality information for 1986 Medicare admissions to 5,971 United States hospitals. Full triennial accreditation surveys were conducted by the Joint Commission on Accreditation of Healthcare Organizations in 1,628 of these institutions in 1986. This report examines the relationship between 1986 Medicare mortality rates and hospital quality, as measured by accreditation survey performance. Hospitals with higher-than-expected and lower-than-expected mortality rates were compared on three measures of accreditation survey performance. These comparisons were made for three mortality groups: overall, stroke, and acute heart disease. No statistically significant (p = 0.05) differences were found in survey performance for any of the mortality groups compared. This lack of association between mortality and hospital quality, as measured by accreditation performance, reinforces concern about the use of mortality rates as measures of quality for public policy or patient decision-making purposes.

Accreditation↗

PubMed1987

Delineating clinical privileges.

Clinical privilege delineation is essential in assuring quality care and minimizing the liability exposure of an institution and its staff. Approaches to privilege delineation include: delineation by practitioner specialty; delineation by patient risk categories; delineation using a list of procedures; and approaches combining these three methods. Regardless of the approach taken, the key to effective privilege delineation is that specific written criteria be applied uniformly to all individuals. Some of the difficulties encountered in the privilege delineation process involve granting privileges for new procedures, monitoring compliance with privileges, and granting privileges that may be performed by members of several departments.

Certification↗

PubMed1987