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Dale W. Bratzler, Surgical Care Improvement Project Performance Measures: Good but Not Perfect, Clinical Infectious Diseases, Volume 56, Issue 3, 1 February 2013, Pages 428–429, https://doi.org/10.1093/cid/cis944
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(See the Quality Improvement Invited Article by Weston et al on pages 424–7.)
The process of development, implementation, and maintenance of national performance measures to assess the quality of healthcare is complex. Topics are selected for quality improvement on the basis of the impact of a clinical condition (mortality, morbidity, costs of care), presence of evidence-rated guidelines to identify best practices that can be measured, and known gaps in performance. Measures are developed after a careful review of guidelines with vetting from clinical experts in the field. Pilot testing occurs through review of samples of patient records with the target condition or with groups of providers who volunteer to participate. Implementation of the measures requires publication of detailed specifications for all data elements that must be collected to evaluate performance, and requires the programming of tools for data collection and analysis that can be utilized to evaluate performance. Maintenance of performance measures to ensure that the specifications are valid and consistent with newly developed medical knowledge requires ongoing review of published evidence. Just as postmarketing surveillance often reveals side effects of medications not identified during clinical trials, rolling out national performance measures to thousands of healthcare providers for implementation often brings to light issues with measure specifications and clinical scenarios not anticipated based on pilot testing. Changes to performance measure specifications often require additional field testing of data elements for abstraction, publication of a new specifications manual, reprogramming of data collection tools, and reprogramming of the data warehouse where information abstracted by healthcare providers is stored.
