0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Commentary |

Performance Measures and Clinical Outcomes

Susan D. Horn, PhD
JAMA. 2006;296(22):2731-2732. doi:10.1001/jama.296.22.2731.
Text Size: A A A
Published online

Extract

Performance measures are created and used to improve clinical outcomes, so it is important to know which measures are associated with better outcomes. The study by Werner and Bradlow1 in this issue of JAMA evaluates the association between performance measures and clinical outcomes in routine hospital care. Despite their large sample size and the use of numerous statistical adjustments and sensitivity analyses, the authors found only small statistically significant or nonsignificant associations between rates of application of performance measures and patient mortality rates for acute myocardial infarction, heart failure, and pneumonia in US hospitals. Even when the associations were statistically significant, the clinical importance was questionable because the mortality rate when a performance measure was applied frequently differed only slightly from the rate when the performance measure was applied infrequently. The authors recognize that “ . . . Hospital Compare measures discrete aspects of care delivery rather than assessing global quality. While these measures have been tightly linked to patient outcomes in clinical trials and are included in clinical practice guidelines [developed by medical experts], risk-adjusted mortality rates are likely influenced by many factors that are independent of these measures . . . .” Although their results suggest slightly larger differences in mortality rates between high- and low-performance hospitals when all the performance measures are combined (Table 4 in the article), the authors acknowledge that these findings still “capture information about only a small portion of the overall care delivered during a hospital stay.”

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

First Page Preview

View Large
First page PDF preview

Figures

Tables

References

Letters

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 29

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles
Jobs
JAMAevidence.com

Users' Guides to the Medical Literature
What are the Results of the Study?

Users' Guides to the Medical Literature
What Are the Results?

brightcove.createExperiences();