title: Can quality of care for patients with cirrhosis be measured?
abstract: BACKGROUND
  The ultimate purpose of measuring quality of care is to discriminate between healthcare providers in order to motivate improvement.  Recently, a set of evidence-based indicators has been proposed for measurement of processes of care for patients with cirrhosis, for example early endoscopy for variceal bleeding.  The objective of this study was to determine whether these indicators can be measured in a reliable and automated fashion in routine practice.
  
  
  METHODS
  We applied the top five indicators, based on agreement of a panel of experts, to hospitalized adults at our institution over a 3-year period.
  
  
  RESULTS
  Only two of the indicators could be reliably measured on the basis of the published wording, and these two still required physician chart review. After applying some assumptions, the indicators were met in 46-100% of cases.  None of the indicators was linked to a single physician or institution in all cases, and none occurred with sufficient frequency to discriminate quality between providers.
  
  
  CONCLUSIONS
  Measuring quality of care in cirrhosis is a laudable objective, but current indicators are not yet ready for administrative use.
authors.affiliation: Department of Gastroenterology, University of Michigan, 1954 Upland Dr, Ann Arbor, MI 48105, USA. JTBassett@aol.com
authors.forename: John T
authors.initials: JT
authors.lastname: Bassett
authors.forename: Michael L
authors.initials: ML
authors.lastname: Volk
mesh_terms: D000328:Adult; D005500:Follow-Up Studies; D006282:Health Personnel / Q000592:standards*; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000628:therapy*; D011785:Quality Assurance, Health Care / Q000379:methods*; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D014481:United States