Important considerations in using indicators to profile providers.

The demand is accelerating for information about the clinical performance of providers. In the more competitive and value-sensitive marketplace that is already developing, purchasers (consumers, employers, and insurers) of health care services will require more information to better assess the relative value of providers' (professional and hospital) services. The cornerstone of a wise, value-based strategy in selecting health care services is careful assessment of each provider's performance based on detailed, quantitative data in the form of clinical indicators. The use of indicators to profile the comparative performances of providers allows purchasers to compare as well as to influence provider performance.

Twelve questions to ask about your outcomes monitoring system--Part II.

Commercial and customized outcomes monitoring systems designed to assess the results of care, whether clinical outcomes or resource use, are not all of equal value or equally appropriate for every use. In creating each system, its developers had to make critical decisions about such matters as definitions of outcomes for study, selection of patients, selection of data elements, methods and timing of data collection, and method of analysis and reporting. Each system represents a unique set of choices that were made. This series of two articles presents answers to 12 questions that will help users understand the basic workings of an outcomes monitoring system--to be able to distinguish good systems from the mediocre and the bad, and to make wise use of a system already in operation. In addition to the six questions presented in the April 1994 issue of Physician Executive, the following six questions are of critical importance in determining a system's value to you and your organization.

Twelve questions to ask about your outcomes monitoring system--Part I.

Outcomes monitoring is an integral part of any decision maker's information resources--the cornerstone of a provider's commitment to quality improvement or of a purchaser's strategy for seeking value. In their eagerness to obtain useful information about provider performance, purchasers and consumers naively may accept flawed evaluations and thereby create perverse incentives for providers that undermine the very qualities they wish to foster. Inaccurate or misleading information about provider performance will lead managers to reward the wrong behavior and so induce more of it. Inaccurate information also can discourage better providers whose performances are not recognized and can lead all providers to distrust and denounce clinical monitoring in general. When these things happen, the great value of outcomes monitoring systems as a tool for quality improvement is lost.