SELECTING DISEASE-OUTCOME PAIRS FOR MONITORING THE QUALITY OF HOSPITAL-CARE

Health care payers and providers are increasingly monitoring hospital discharge data bases for adverse events as markers for quality of care . The principal criticisms of these analyses have focused on the imped iments to risk adjustment posed by the incompleteness and inaccuracy o f the data bases. However, efforts to address the inadequacies of the data bases will not correct deficiencies of the analytic process. Thes e deficiencies arise from the application of one adverse outcome to al l disease states. Instead, analysis should be restricted to comparison s of subgroups of patients in which a close fit exists between the qua lity of care for the disease state and the expected outcome. Furthermo re, these disease-outcome pairs should be minimally subject to measure ment error. The authors present a conceptual framework for developing such meaningful disease-outcome pairs, and using the hospital discharg e data base of the Department of Veterans Affairs, show how the framew ork can be used to devise a monitoring strategy for re-admission.