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Medicine in the Era of Outcomes Measurement

2009; Lippincott Williams & Wilkins; Volume: 2; Issue: 3 Linguagem: Inglês

10.1161/circoutcomes.109.873521

1941-7705

Harlan M. Krumholz,

Pharmaceutical Practices and Patient Outcomes

proclaimed that two hospitals in Massachusetts, including an institution considered one of the nation's best, had significantly higher than expected mortality rates for patients undergoing percutaneous coronary intervention (PCI).The story was based on the in-hospital risk-standardized mortality rates for hospitals throughout the state, released by the Massachusetts Department of Public Health. 1 The unexpected result raised questions, concerns, and some confusion about hospital performance and the validity of the measures.The recent focus on hospital outcomes measures seems likely to intensify with the anticipated release by the Centers for Medicare & Medicaid Services of 30-day riskstandardized mortality and readmission rates for acute myocardial infarction, heart failure, and pneumonia.After more than a decade of focus on structure and process, there is a growing sense that, in a health care system that strives to be patient-centered, we need assessments of what actually happens to patients.The structural characteristics of an institution-such as equipment, certification, or procedural volume-do not guarantee higher quality of patient care or superior outcomes, nor does its reputation necessarily reflect actual experience.Process measures can capture key actions