FOR WHAT SHOULD HOSPITALS BE ACCOUNTABLE

Background: An underlying assumption in discussing for what hospitals should be accountable is that the public trusts that hospitals will ac t in patients' best interests. Therefore, hospitals must be accountabl e to demonstrate that they deliver high-quality care. They must also d emonstrate that they are doing so as efficiently as possible for the p atients of public payers (and others). Issues: Current mechanisms for public accountability are neither comprehensive nor do they incorporat e a systematic approach for ensuring that hospitals deliver high-quali ty care. Current efforts to establish which information is helpful for monitoring the quality of hospital care are duplicative and incomplet e. In addition, many current approaches are not reliable or valid; the re is no routine mechanism for evaluating reliability and validity of data released to the public. Conclusion: Recommendations are made rega rding what kinds of information hospitals should be required to give t o federal agencies. A federally organized effort is needed to develop standard quality measures, as well as specification of the state or ot her agencies that should be required to monitor the quality of hospita l care for all patients and of the requirements for ongoing evaluation of the reliability and validity of the data used to assess quality of care. Changes in policy are suggested that would facilitate a federal effort to develop and maintain standard quality measures.