title: Performance measures for pneumonia: are they valuable, and are process measures adequate?
abstract: OBJECTIVE
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Oklahoma Foundation for Medical Quality, Oklahoma City, Oklahoma 73134, USA. dbratzler@okqio.sdps.org
authors.forename: Dale W
authors.initials: DW
authors.lastname: Bratzler
authors.forename: Wato
authors.initials: W
authors.lastname: Nsa
authors.forename: Peter M
authors.initials: PM
authors.lastname: Houck
mesh_terms: D017723:Drug Utilization Review; D006801:Humans; D011014:Pneumonia / Q000145:classification / Q000628:therapy*; D017064:Process Assessment, Health Care / Q000379:methods; D011785:Quality Assurance, Health Care / Q000379:methods*; D019984:Quality Indicators, Health Care / Q000592:standards; D016896:Treatment Outcome; D014481:United States