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Process Measures and Short-term Mortality for Acute Myocardial Infarction—Reply
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In Reply: Drs McKalip and Harbaugh recognize our key point that hospital performance on the AMI core process measures is not a strong predictor of hospital performance on 30-day mortality following AMI. As they suggest, our finding is consistent with previous data by Williams et al1 showing improvement in process measures with little change in hospital mortality rates. Our main message is therefore that both process and outcome, adequately risk-adjusted, need to be evaluated and reported to characterize hospital performance. Measuring process alone is not adequate. We agree that reporting of performance measures can lead to the unintended consequence of clinicians avoiding higher-risk patients; however, with adequate risk adjustment at the hospital level, this incentive can be minimized.
The more central concern raised is whether there should be additional process measures integrated as core AMI performance indicators. We agree that there are risks in having too many indicators. Measurement and . . . [Full Text of this Article]
Elizabeth H. Bradley, PhD;
Harlan M. Krumholz, MD, SM
harlan.krumholz@yale.edu
Yale University School of Medicine
New Haven, Conn
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RELATED LETTER
Process Measures and Short-term Mortality for Acute Myocardial Infarction
David McKalip and Robert E. Harbaugh
JAMA. 2006;296(21):2557.
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RELATED ARTICLE
Hospital Quality for Acute Myocardial Infarction: Correlation Among Process Measures and Relationship With Short-term Mortality
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JAMA. 2006;296(1):72-78.
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