October 6, 2015

Facilitating Quality ImprovementPushing the Pendulum Back Toward Process Measures

Author Affiliations
  • 1Surgical Outcomes and Quality Improvement Center, Department of Surgery, Northwestern University, Chicago, Illinois
  • 2Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, Illinois

Copyright 2015 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA. 2015;314(13):1333-1334. doi:10.1001/jama.2015.12470

Public reporting and pay-for-performance programs in health care are critically important and effective levers for quality improvement (QI). However, measurement problems have been identified with many current initiatives that limit the utility of the metrics for QI, the engagement of clinicians in QI, and the value of the information available to patients. Some have suggested focusing decisively on outcomes measures rather than process-of-care metrics.1 It seems that the Centers for Medicare & Medicaid Services (CMS) is committed to moving away from process measures.2 For example, some would advocate focusing more on venous thromboembolism (VTE) rates (outcome) rather than examining VTE prophylaxis adherence (process). Even though the decades-old debate regarding the merits of process vs outcome measures currently appears to be swinging toward outcomes, this recent policy shift away from process measures is a mistake: process measures are critical for driving QI.

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