title: Chief complaint-based performance measures: a new focus for acute care quality measurement.
abstract: Performance measures are increasingly important to guide meaningful quality improvement efforts and value-based reimbursement. Populations included in most current hospital performance measures are defined by recorded diagnoses using International Classification of Diseases, Ninth Revision codes in administrative claims data. Although the diagnosis-centric approach allows the assessment of disease-specific quality, it fails to measure one of the primary functions of emergency department (ED) care, which involves diagnosing, risk stratifying, and treating patients' potentially life-threatening conditions according to symptoms (ie, chief complaints). In this article, we propose chief complaint-based quality measures as a means to enhance the evaluation of quality and value in emergency care. We discuss the potential benefits of chief complaint-based measures, describe opportunities to mitigate challenges, propose an example measure set, and present several recommendations to advance this paradigm in ED-based performance measurement.
authors.affiliation: Division of Emergency Medicine and Institute for Public Health, Washington University School of Medicine, St. Louis, MO. Electronic address: griffeyr@wustl.edu.
authors.forename: Richard T
authors.initials: RT
authors.lastname: Griffey
authors.affiliation: Departments of Emergency Medicine and Health Policy, The George Washington University School of Medicine, Washington, DC.
authors.forename: Jesse M
authors.initials: JM
authors.lastname: Pines
authors.affiliation: Department of Emergency Medicine, Institute for Patient Safety, Cleveland Clinic, Cleveland, OH.
authors.forename: Heather L
authors.initials: HL
authors.lastname: Farley
authors.affiliation: Department of Emergency Medicine, Christiana Care Health System, Wilmington, DE.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Phelan
authors.affiliation: Department of Emergency Medicine, Northwestern Feinberg School of Medicine, Chicago, IL.
authors.forename: Christopher
authors.initials: C
authors.lastname: Beach
authors.affiliation: Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Jeremiah D
authors.initials: JD
authors.lastname: Schuur
authors.affiliation: Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT.
authors.forename: Arjun K
authors.initials: AK
authors.lastname: Venkatesh
mesh_terms: D002637:Chest Pain / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D004632:Emergency Medical Services / Q000592:standards*; D006801:Humans; D011785:Quality Assurance, Health Care / Q000379:methods*; D058996:Quality Improvement; D019984:Quality Indicators, Health Care