Hok's-Focus

Link to the entire issue:  http://content.healthaffairs.org/content/32/12.toc

Quality Measurement In The Emergency Department: Past And Future

1. Jeremiah D. Schuur1,*, 
2. Renee Y. Hsia2, 
3. Helen Burstin3, 
4. Michael J. Schull4 and
5. Jesse M. Pines5

+Author Affiliations

1. ¹Jeremiah D. Schuur is an attending physician; chief of the Division of Health Policy Translation; and director of quality, patient safety, and performance improvement, all in the Department of Emergency Medicine, Brigham and Women’s Hospital, in Boston, Massachusetts. He is also an assistant professor of emergency medicine at Harvard Medical School.
2. ²Renee Y. Hsia is an associate professor in the Department of Emergency Medicine at the University of California, San Francisco.
3. ³Helen Burstin is senior vice president for performance measures at the National Quality Forum, in Washington, D.C.
4. ⁴Michael J. Schull is the president and CEO of the Institute for Clinical Evaluative Sciences in Toronto, Ontario, and a professor in the Division of Emergency Medicine, Department of Medicine, at the University of Toronto.
5. ⁵Jesse M. Pines is director of the Office for Clinical Practice Innovation, School of Medicine and Health Sciences, and a professor of emergency medicine and health policy at the George Washington University, in Washington, D.C.

1. ↵*Corresponding author

Abstract

As the United States seeks to improve the value of health care, there is an urgent need to develop quality measurement for emergency departments (EDs). EDs provide 130 million patient visits per year and are involved in half of all hospital admissions. Efforts to measure ED quality are in their infancy, focusing on a small set of conditions and timeliness measures, such as waiting times and length-of-stay. We review the history of ED quality measurement, identify policy levers for implementing performance measures, and propose a measurement agenda. Initial priorities include measures of effective care for serious conditions that are commonly seen in EDs, such as trauma; measures of efficient use of resources, such as high-cost imaging and hospital admission; and measures of diagnostic accuracy. More research is needed to support the development of measures of care coordination and regionalization and the episode cost of ED care. Policy makers can advance quality improvement in ED care by asking ED researchers and organizations to accelerate the development of quality measures of ED care and incorporating the measures into programs that publicly report on quality of care and incentive-based payment systems.