Relating outcomes to processes of care: the Maryland Hospital Association's Quality Indicator Project (QI Project).

BACKGROUND

The Maryland Hospital Association's Quality Indicator Project (QI Project) is a program of indicator development and application that has grown from 7 hospitals in 1987 to more than 700 hospitals today.

METHODOLOGY

Expert panels help to create sets of indicators that describe events involved in a specific sequence of patient care. Each hospital collects data elements for the 21 indicators on a quarterly basis using specifically designed data-collection software. Indicator data are adjusted for case complexity, risk of adverse outcomes, and patient group characteristics. A report is developed that states the rate of occurrence of each indicator and how the hospital's indicator rate compares to other hospitals in the database. Hospitals then use this information to determine if specific processes in their delivery of care yield results that deviate from those of other hospitals. The QI Project promotes regional sharing of information about specific hospital initiatives that might benefit other participants. It also provides a model to use in interpreting what the indicator data reveal about hospital performance.

OPERATIONAL ISSUES

QI Project is testing process indicators for patient-level and service-level data to supplement current aggregate-level trend and profile analysis. Indicator data are shared solely with participating systems, but changes in the confidentiality policy are being studied. Reliability assessment surveys are periodically conducted.

EXAMPLES

Case studies portray improvement of processes prompted by indicator data for unscheduled admission following ambulatory surgery, for surgical wound infections, and for reducing emergency room waiting times.

CONCLUSIONS

The chief contribution of the QI Project and similar projects may not be that they identify all issues of quality, but rather that they may help develop a generation of hospital professionals who will be better able to quantify, evaluate, and improve health care quality.