Quality and measurement #5
 Astrid Guttmann, MD, MSc
Scientist, Institute for Clinical Evaluative Sciences
 Amresh Hanchate, PhD
Research Assistant Professor, GIM, Boston University
 George Jackson, PhD, MHA
Research Health Scientist, HSR&D Services, Durham VA
 Christopher Landrigan, MD, MPH
Asst. Prof. of Pediatrics and Medicine, Harvard Medical School
 Jany Rademakers, DR
Head of Research Department, Netherlands Institute for HSR
Quality and measurement #5
 How does inclusion of same day surgeries, and follow-up outpatient
data, change findings derived from the use of pediatric safety
indicators?
 To what degree does inclusion of laboratory elements improve risk
prediction of in-hospital mortality among VA patients with seven
conditions?
 What is the quality of care for colorectal cancer with the VA health
system with respect to seven guideline measures and 3 timeliness of
care measures?
 How suitable is the IHI “global trigger tool” for use as a measure of
patient harm at individual hospital and national levels?
 Can patient-based measures be used to identify differences in
preferences across conditions, and to yield more meaningful targets
for quality improvement efforts?
Comments
 Many dimensions of quality; challenges of measurement so
that robust and useful to inform health policy and clinical care
(Guttman and Hanchate)
 Degree to which quality may be in eye of beholder, and
sensitivity of measures such as safety indicators to methods
and teams whereby they are measured (Landrigan)
 Mixed-methods approaches to “get under the hood” (Jackson)
 Potential of patient-based measures as complement to others;
challenge (and opportunity) of navigating clinical application
of these measures due to patient heterogeneity (Rademakers)
 If [truly] no improvement in patient safety over time
(Landrigan), what aspects of health care reform offer greatest
promise?