Measurement of Hard Outcomes Trumps Process Measurement (Again)

Researchers this week cast doubt on the wisdom of looking first at processes and operations to drive quality improvement and urged Medicare, which provides health insurance to people 65 and older, to focus on “hard” outcomes such as rates of surgical deaths and serious complications. In a study published this Monday in Archives of Surgery, a medical journal, and reported this Tuesday by the Wall Street Journal (Thomas M. Burton, “Medicare Faulted on Surgery Evaluation,” October 19, 2010, A6), researchers at the University of Michigan said a better way to lower rates of death and serious complications is to focus on actual outcomes like death rates and to publicize those  rates for all hospitals. This focus on actual outcomes is something my colleagues and I have been advocating for courts since the promulgation of the Trial Court Performance Standards twenty years ago and continue to do so with the CourTools and the Appellate CourTools. (See one of the first few postings here, "A Preference for Outcome Measures," Made2Measure, September 28, 2005).


The University of Michigan researchers looked at over 2,000 hospitals and 325,052 surgeries with high risks of death or serious complications. They found little evidence of a consistent relationship – and this is the important part of their findings – between the rates of surgical deaths and serious complications 30 days after surgery and how well the hospitals complied with the processes prescribed by Medicare, such as giving hospital patients aspirin at discharge after heart attack treatment and doctors giving pneumonia patients antibiotics within six hours of arriving in the hospitals. In other words, there was no evidence linking what Medicare might have thought are “best practices” to improved outcomes for patients.


“I definitely think some of the money we’re spending measuring process compliance doesn’t promote quality,” said Lauren H. Nicholas, the lead University of Michigan researcher said in an interview with the Wall Street Journal. “We feel [Medicare] should be moving toward greater use of measures of outcomes.”

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