Process Measures of Quality of Care: A Strategy for Validation against Outcomes

Abstract

<p>Quality of care evaluation strategies are needed for meaningful assessment of health care delivery for research, quality assurance and educational purposes.</p> <p>For the purpose of improving strategies for measuring quality of care, this thesis first reviews methodologic features of available measurement strategies as reported in the current scientific literature. Secondly it proceeds with the development of a descriptive research design to evaluate the criterion validity of a strategy for evaluating process items by comparison with comprehensive outcome measures including physical, emotional and social function. Thirdly, the development of a new strategy for measurement of interpersonal skills, which is incorporated into the process evaluation, is described.</p> <p>The objective of the study is to study patients with acute myocardial infarction in order to determine whether measurable differences in the care administered to and received by these patients result in clinically significant differences in these patient's health status six months later. Acute myocardial infarction has been chosen as a disease appropriate for the testing of this strategy because if its high incidence, its functional impact upon the patient, the variation in process management items performed by different physicians, the different clinical settings involved, the relative diagnosis and availability of an inception cohort. A community hospital setting has been selected for the reason that, compared with a teaching hospital setting, the generalisability of the study to the practice of other physicians will be greater since the majority of physicians involved in the care of patients with acute myocardial infarction work in community hospital settings.</p>