ABSTRACT
The purpose of this article is to relate the experiences of a panel of industry experts and Maryland Hospital Association (MHA) staff who worked together to develop and pilot test a set of comparative performance indicators for psychiatric care. MHA's experiences with the Quality Indicator Project served to provide a sound structure for indicator development and testing. This paper explores the premise on which the indicator set was developed, the work of the expert panel, and the participation and contribution of the pilot sites.
Subject(s)
Hospitals, Psychiatric/standards , Psychiatric Department, Hospital/standards , Quality of Health Care/standards , Health Services Research , Maryland , Outcome and Process Assessment, Health Care , Pilot Projects , Program DevelopmentABSTRACT
This paper describes the technical and conceptual aspects in the development of an indicator project to measure hospital performance. Almost a decade ago, a research based--hence explorative, series of inpatient and ambulatory care indicators were developed. This paper describes some of the most fundamental technical and applied knowledge gleaned from the study and applicable to all quality assurance/quality improvement activities. These findings, and the resulting indicator development guiding principles, are based on more than 900 hospitals' experience in the US, Japan, and England. Although this paper presents the necessary scientific underpinning for a valid and reliable analysis, its principal emphasis is on the practical applicability of this decade old research project aimed at measuring select outputs of performance and identifying and explaining the determinants of these outputs.
Subject(s)
Hospitals/standards , Quality of Health Care/standards , Societies, Hospital , England , Guidelines as Topic , Health Status , Japan , Maryland , Outcome and Process Assessment, Health Care/standards , Pilot Projects , Reference Values , Reproducibility of Results , United StatesABSTRACT
BACKGROUND: The Maryland Hospital Association's Quality Indicator Project (QI Project) is a program of indicator development and application that has grown from 7 hospitals in 1987 to more than 700 hospitals today. METHODOLOGY: Expert panels help to create sets of indicators that describe events involved in a specific sequence of patient care. Each hospital collects data elements for the 21 indicators on a quarterly basis using specifically designed data-collection software. Indicator data are adjusted for case complexity, risk of adverse outcomes, and patient group characteristics. A report is developed that states the rate of occurrence of each indicator and how the hospital's indicator rate compares to other hospitals in the database. Hospitals then use this information to determine if specific processes in their delivery of care yield results that deviate from those of other hospitals. The QI Project promotes regional sharing of information about specific hospital initiatives that might benefit other participants. It also provides a model to use in interpreting what the indicator data reveal about hospital performance. OPERATIONAL ISSUES: QI Project is testing process indicators for patient-level and service-level data to supplement current aggregate-level trend and profile analysis. Indicator data are shared solely with participating systems, but changes in the confidentiality policy are being studied. Reliability assessment surveys are periodically conducted. EXAMPLES: Case studies portray improvement of processes prompted by indicator data for unscheduled admission following ambulatory surgery, for surgical wound infections, and for reducing emergency room waiting times. CONCLUSIONS: The chief contribution of the QI Project and similar projects may not be that they identify all issues of quality, but rather that they may help develop a generation of hospital professionals who will be better able to quantify, evaluate, and improve health care quality.
