Address correspondence to Rachel M. Werner, M.D., Ph.D., 1230 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104. Dr. Werner is with the Center for Health Equity Research and Promotion, Philadelphia, VA Division of General Internal Medicine, University of Pennsylvania, and Leonard Davis Institute of Health Economics, University of Pennsylvania. Eric T. Bradlow, Ph.D., is with the Departments of Marketing, Statistics, and Education, University of Pennsylvania, Philadelphia, PA, and the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA. David A. Asch, M.D., M.B.A., is with the Center for Health Equity Research and Promotion, Philadelphia, VA Division of General Internal Medicine, University of Pennsylvania, Philadelphia, PA, and the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.
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Healthcare Organizational Performance Measures
Does Hospital Performance on Process Measures Directly Measure High Quality Care or Is It a Marker of Unmeasured Care?
Article first published online: 20 DEC 2007
DOI: 10.1111/j.1475-6773.2007.00817.x
© Health Research and Educational Trust
Additional Information
How to Cite
Werner, R. M., Bradlow, E. T. and Asch, D. A. (2008), Does Hospital Performance on Process Measures Directly Measure High Quality Care or Is It a Marker of Unmeasured Care?. Health Services Research, 43: 1464–1484. doi: 10.1111/j.1475-6773.2007.00817.x
Publication History
- Issue published online: 20 SEP 2008
- Article first published online: 20 DEC 2007
Keywords:
- Quality of care;
- quality improvement;
- performance measurement;
- process measures
Objective. Quality measures may be associated with improved outcomes for two reasons. First, measured activities may directly improve care. Second, success on these measures may be a marker for other unmeasured aspects of high quality care. Our objective is to test the contribution of both possible effects.
Data Sources. 2004 Medicare data on hospital performance from Hospital Compare and risk-adjusted mortality rates from Medicare Part A claims.
Study Design. We studied 3,657 acute care U.S. hospitals and compared observed differences in condition-specific hospital mortality rates based on hospital performance with expected differences in mortality from the clinical studies underlying the measures.
Principal Findings. Differences in observed mortality rates across U.S. hospitals are larger than what would be expected if these differences were due only to the direct effects of delivering measured care.
Conclusions. Performance measures reflect care processes that both improve care directly and are also markers of elements of health care quality that are otherwise unmeasured. This finding suggests that process measures capture important information about care that is not directly measured, and that these unmeasured effects are in general larger than the measured effects.