Use of process measures to monitor the quality of clinical practice

doi:10.1136/bmj.39317.641296.AD

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

Richard J Lilford, professor of clinical epidemiology¹, Celia A Brown, research fellow¹, Jon Nicholl, director MCRU policy research programme²

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

Correspondence to: R J Lilford r.j.lilford@bham.ac.uk

Outcomes of care are a blunt instrument for judging performanceand 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 externalagencies, such as the Health Care Commission in England andMedicare in the Unites States. Such agencies increasingly concernthemselves with the quality of care and not just measures ofthroughput, such as waiting times and the average length ofhospital stay. Measures of clinical quality are also likelyto be used increasingly to monitor the performance of individualdoctors.¹ But how should quality be measured? The intuitiveresponse is to measure the outcomes of care—after all,patients use the service to improve their health outcomes. Weargue that this beguiling solution has serious disadvantagesbecause of the poor correlation between outcome and qualityand that use of outcome as a proxy for quality is a greaterproblem when the data are used for some purposes than for others.

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

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