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BMJ 2005; 331 doi: (Published 08 September 2005) Cite this as: BMJ 2005;331:537
  1. Christopher Martyn, associate editor (

    Process measures are related to survival in elderly patients

    The quality of medical care is best judged by patients' outcomes. But such data are often slow and difficult to collect. It's easier to measure process instead—the proportion of eligible patients who received a recommended treatment, for example. Where the recommended treatment is established as effective, this is fair enough. In many settings, however, particularly in the community, the relation between improved performance on measures of process of care and better health outcomes is little more than an assumption. The findings of a study of elderly people, in which this assumption was put to the test, are reassuring.

    Using medical records of almost 400 elderly people living in the community, researchers assessed the quality of medical care received by using a broad set of process indicators. On average, these people had received about half the recommended care, but there was a large variation between individuals. These people were followed up for three years. After adjustment for sex, illnesses at baseline, and frequency of use of health services, no relation between quality and mortality was evident in the first 18 months of observation. After this, people with higher quality scores had lower mortality, and the difference increased as time went on.

    Varicella vaccination reduces use of health care

    Before varicella vaccine was invented, almost everyone experienced chickenpox, usually in childhood. Routine vaccination started in the United States in 1995 and, by 2002, coverage in children aged 19 to 35 months was more than 80%. Not surprisingly, the incidence of chickenpox has declined considerably. Rather more importantly, medical complications related to varicella have also fallen substantially.

    Using data from a national database of health insurance plans, investigators tracked trends in varicella related hospitalisations, visits to doctors, and medical costs between 1994 and 2002. Compared with the prevaccination period, hospitalisations fell by 88% and visits to doctors by 59%. The …

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