title: Commentary: inaccurate data on the quality of care may do more harm than good--an alternative approach is required.
abstract: Recently the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) announced that it would integrate the use of clinical outcomes and other performance measures into the accreditation process through its new "ORYX" program. This JCAHO initiative represents a significant new development that will include more than 100 different performance measurement systems, most of which are available through commercial firms and outside organizations. However, we see some potential problems with this new initiative. This is because some indicators recommended by JCAHO may be questionable due to the fact they are based on flawed methodologies that could result in biased and confounded data. To illustrate some of the potential adverse effects that could result from using such data to compare health care providers and facilities, we discuss some common problems associated with several widely available performance measurement systems. We then suggest an alternative approach that could potentially avoid many of these problems in the future.
authors.affiliation: Department of Outcomes Research, Catholic Health Initiatives--Southeast Region, Louisville, KY 40232-4037, USA. bosc100w@wonder.em.cdc.gov
authors.forename: J A
authors.initials: JA
authors.lastname: Boscarino
authors.forename: J
authors.initials: J
authors.lastname: Chang
mesh_terms: D015982:Bias; D003625:Data Collection / Q000379:methods / Q000592:standards; D006761:Hospitals / Q000592:standards*; D006801:Humans; D007255:Information Services; D007591:Joint Commission on Accreditation of Healthcare Organizations; D017063:Outcome Assessment, Health Care / Q000379:methods* / Q000592:standards; D019984:Quality Indicators, Health Care; D015203:Reproducibility of Results; D012107:Research Design; D012984:Software; D014481:United States