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Performance measures for pneumonia: are they valuable, and are process measures adequate?

Bratzler, Dale Wa; Nsa, Watoa; Houck, Peter Mb

Current Opinion in Infectious Diseases: April 2007 - Volume 20 - Issue 2 - p 182–189
doi: 10.1097/QCO.0b013e3280495468
Respiratory infections

Purpose of review Pneumonia has been the target of large national initiatives to measure and report quality of care. Measures of pneumonia care are now being used for public reporting and pay-for-performance in an effort to increase provider accountability for healthcare quality in the USA. Increasingly, concerns have been raised about the potential for unintended consequences of performance measurement and reporting that might lead to patient harm.

Recent findings Since 1999, there have been substantial improvements in performance on measures of pneumonia processes of care, and patient clinical outcomes have improved. The association between improved clinical outcomes and processes of care for pneumonia, however, is not clear based on available national data. The increasing use of process measures for hospital accountability has created the continual need to re-evaluate the relationship between processes being measured and desired patient outcomes. While there is little direct evidence of unintended consequences of performance measurement, concerns have been raised about the potential for direct or indirect harm to patients.

Summary Measuring processes of care for pneumonia is feasible and appears to have accelerated the pace of quality improvement. There is an ongoing need to develop new measures of pneumonia quality that focus on patient outcomes, care transitions, and efficiency of care.

aOklahoma Foundation for Medical Quality, Oklahoma City, Oklahoma

bDepartment of Epidemiology, University of Washington, Seattle, Washington, USA

Correspondence to Dale W. Bratzler, DO, MPH, QIOSC Medical Director, Oklahoma Foundation for Medical Quality, 14000 Quail Springs Parkway, Suite 400, Oklahoma City, OK 73134, USA Tel: +1 405 840 2891; fax: +1 405 840 1343; e-mail:

© 2007 Lippincott Williams & Wilkins, Inc.