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Letters |

Risk Adjustment, Quality Assessment, and Process of Care—Reply

Lisa I. Iezzoni, MD, MSc
JAMA. 1998;279(12):910-911. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-12-jbk0325.
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In Reply.—Although Dr Huff appears to suggest otherwise, many organizations nationwide continue to examine risk-adjusted mortality rates as a first-line effort at assessing hospital performance. For example, the California Office of Statewide Health Planning and Development just released its third report on mortality from acute myocardial infarction in more than 400 hospitals statewide.1 However, as I have noted elsewhere, a complete evaluation of quality requires a multidimensional approach.2,3 Processes of care certainly are the central consideration when efforts move beyond quality assessment (the topic of my article) into quality improvement. As Lohr4 has noted, "When outcomes are poorly linked to specific medical practices . . . , they offer little guidance for improving quality of care, which militates against their use in quality assessment and assurance." I strongly agree with Lohr's4 further point: "I view the continued debate about whether process or outcomes are the preferable measure of quality fundamentally unproductive, because both are needed."

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