Letters Section Editor: Robert M. Golub, MD, Senior Editor.
In Reply: Drs McKalip and Harbaugh recognize our key point that hospital performance on the AMI core process measures is not a strong predictor of hospital performance on 30-day mortality following AMI. As they suggest, our finding is consistent with previous data by Williams et al1 showing improvement in process measures with little change in hospital mortality rates. Our main message is therefore that both process and outcome, adequately risk-adjusted, need to be evaluated and reported to characterize hospital performance. Measuring process alone is not adequate. We agree that reporting of performance measures can lead to the unintended consequence of clinicians avoiding higher-risk patients; however, with adequate risk adjustment at the hospital level, this incentive can be minimized.
Bradley EH, Krumholz HM. Process Measures and Short-term Mortality for Acute Myocardial Infarction—Reply. JAMA. 2006;296(21):2557-2558. doi:10.1001/jama.296.21.2557-b