BMJ  2007;335:648-650 (29 September), doi:10.1136/bmj.39317.641296.AD

Analysis

Use of process measures to monitor the quality of clinical practice

¹ Department of Public Health and Epidemiology, University of Birmingham, Birmingham B15 2TT, ² School of Health and Related Research, University of Sheffield, Sheffield S1 4DA

Outcomes of care are a blunt instrument for judging performance and should be replaced, say Richard J Lilford, Celia A Brown, and Jon Nicholl

The first 150 words of the full text of this article appear below.

Healthcare organisations are increasingly scrutinised by external agencies, such as the Health Care Commission in England and Medicare in the Unites States. Such agencies increasingly concern themselves with the quality of care and not just measures of throughput, such as waiting times and the average length of hospital stay. Measures of clinical quality are also likely to be used increasingly to monitor the performance of individual doctors.¹ But how should quality be measured? The intuitive response is to measure the outcomes of care—after all, patients use the service to improve their health outcomes. We argue that this beguiling solution has serious disadvantages because of the poor correlation between outcome and quality and that use of outcome as a proxy for quality is a greater problem when the data are used for some purposes than for others.

Purpose of measurement

Data on quality can be used either for internal quality improvement or for external . . . [Full text of this article]

Outcomes and quality

Using outcomes for sanction or reward

Process: an alternative measure

Selecting and measuring clinical processes

Is performance management effective?

Are outcome measures obsolete?

Summary points

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Outcomes Remain The Gold Standard

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bmj.com, 3 Oct 2007 [Full text]