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Invited Critique
December 21, 2009

Assessment of Hospital Performance: The Need to Complete the “Hat Trick”Comment on “Hospital Performance in Caring for Injured Patients”

Arch Surg. 2009;144(12):1126. doi:10.1001/archsurg.2009.222

The Donabedian concept of quality highlights three paramount components: structure, process, and outcomes. Understandably, as the pressure continues to mount for documentation of performance improvement in every aspect of health care provision, it is imperative that health care professionals demonstrate, in an evidence-based fashion, better outcomes for a specific approach or management option. Because we have an already brittle economy that is being further crippled by escalation of health care expenditures, the following question can never be considered merely rhetorical: “What is the method (or metric) for determining the impact of a proposed process or intervention on clinical outcome?” Although this is a well-written article, the authors, unfortunately, do not provide any documentation of an improved outcome based on their proposed intervention.

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