DO PERFORMANCE INDICATORS MAKE A DIFFERENCE

Background: The Maryland Hospital Association, Inc (MHA) Quality Indic ator (QI) Project(R), a program of indicator development and applicati on, includes more than 1,100 participating hospitals. Access to data i s limited to participants to promote improvement through comparison ac ross hospitals. Participating hospitals have identified and acted on o pportunities for improvement in information systems, communication acr oss departments of appropriateness of practice, and improvement ''beyo nd the hospital door''. Case study 1: Two teams were formed to address waiting time in the emergency department and failure of patients to f ind treatment. Improvements, including rapid modification of available inpatient beds, additional staffing during high-census periods, and s treamlined processes for lab work and imaging turnaround times, were f ollowed by better indicator performance. ase study 2: A hospital disco vered three causes for a high rate of unscheduled admissions following ambulatory surgery. Interventions included extending the hours of the Same Day Surgery Unit (to solve a urination problem) and changing the anesthesia used (to reduce nausea and vomiting). Case Study 4: To suc cessfully bring its cesarean section (C-section) rate down closer to t he statewide rate, one hospital had physicians encourage patients with previous C-sections to undergo a trial of labor, promoted the use pac kaging to facilitate the use of prostaglandin gel to induce cervical d ilation. Conclusions: The QI Project(R) continues to deal with issue c oncerning quality of data versus quality of care, the correlation betw een indicator rates and care processes, and the usefulness of severity adjustment.