PEJ: Assign numbers to outcomes to track hospital performance
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“The backbone of the concept of quality is defining care that is appropriate,” wrote Peter L. Duffy, MD, from Pinehurst Cardiology Consultants in Pinehurst, N.C. “Inappropriate care has no quality.”
However, Duffy suggested that "appropriateness can be viewed as something that is suitable or proper for the circumstances," and went to define various levels to help categorize care:
- All information suggests no benefit from intended action;
- Most information indicates action is inappropriate and may cause harm;
- Information is limited or suspect; and
- Insufficient information exists to define this care as appropriate or not appropriate.
While some will argue that it isn’t fair to hold clinicians to outcome measures when assessing quality, others feel process measures are more reliable determinants of quality as they are easier to track, more objective and reproducible, Duffy acknowledged.
“However, … we in healthcare will be judged by the results we achieve, not by the level of effort we demonstrate,” he wrote. “Payors and patients alike will seek results and our systems must be geared to produce desired results, demonstrate that we do it and that we do it consistently.”
Duffy concluded by suggesting the following scale:
- 6 – The outcome produced the intended result. No harm was done to the patient (safe), and the action had its intended consequence.
- 5 – The outcome produced most of the intended result (90 percent or greater) with no harm to the patient.
- 4 – The outcome produced some of the intended result (50-90 percent) with no harm to the patient.
- 3 – The outcome produced harm to the patient that was unavoidable due to the clinical condition of the patient.
- 2 – The outcome produced only some of the expected result with no harm to the patient.
- 1 – The outcome resulted in minor unexpected harm to the patient.
- 0 – The outcome resulted in major unexpected harm to the patient.