ABSTRACT
Profiling, the process of comparing the quality of care delivered by medical care providers to a normative standard, is central to much of the quality assessment effort. Providers of medical care can be assessed according to either process-based or outcome-based measures. The former relate to the appropriateness of the delivery of treatments and other medical processes whereas the latter relate to patient-specific outcomes of care, such as mortality or patient functioning, that resulted from treatments. Normand, Glickman, and Gatsonis (1997) and Normand, Glickman, and Ryan (1997) describe profiling medical care providers using outcome measures. They compare mortality rates after an acute myocardial infarction (AMI) across hospitals and discuss many of the statistical issues involved in outcome-based profiling, including risk-adjustment, and the development of performance indices. In this Chapter, we present a case-study for profiling medical providers using processbased measures. Process measures can be more sensitive than outcome measures, as poor process does not always lead to poor outcomes (Brook et al., 1996). However, process measures are only valid to the extent to which it can be demonstrated that adherence to recommended processes of care leads to better patient outcomes.
