INCREASING PRESSURE TO IMPROVE CARE

The U.S. government has developed the Agency for Healthcare Research and Quality (AHRQ), the National Quality Forum, and the Center for Medicare and Medicaid Services to promote the development and reporting of health care quality measures. ^[83] The importance and utility of publicly reported measures of quality of care have become widely accepted. For example, the Leapfrog Group, a health care purchasing consortium of more than 130 Fortune 500 companies, developed a national measure of quality of ICU care (www.leapfroggroup.org). The Leapfrog Group seeks to steer their employees to ICUs that are staffed by ICU physicians. Birkmeyer and colleagues^[84] estimated that implementation of the Leapfrog ICU standard could save up to 54,000 lives per year if used by all nonrural hospitals in the United States. These estimates assumed that ICU physician staffing reduces mortality by 10%; later evidence suggests that ICU physicians reduce mortality by 30%, making the number of lives saved closer to 162,000 per year.

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is developing quality measures for several areas, including ICU care (www.jcaho.org). Their ORYX initiative was developed to integrate performance measurement data into the accreditation process and to permit rigorous comparison of the actual results of care across hospitals. As part of the ORYX initiative, a JCAHO task force is developing a set of measures evaluating quality of ICU care that will be broadly implemented, including public reporting, in U.S. hospitals in 2004 or 2005.

As consumers, payers, regulators, and accreditors require evidence regarding quality of care, the demand for quality measures probably will grow. To meet these demands, anesthesiologists must be able to evaluate the quality of care they provide.