Hospital performance indicators in the Netherlands: a preterm delivery

Information on the performance of physicians and hospitals is increasingly used by health authorities to monitor and improve health care. Two general types of health care assessments exist: those that measure outcome and those that measure process. Examples of outcome-based reporting include those of US cardiac surgeons’ and hospitals’ mortality rates following coronary artery bypass graft (CABG) surgery.2 Outcome-based reporting may seem to provide objective measures of performance. However, given the many variables that impact on clinical outcomes, most importantly the differences in types of patients and referral patterns (‘case-mix’) among hospitals, these parameters may at the same time be misleading.3 Process-based assessments, frequently called quality indicators, report on rates of medical interventions, such as screening tests and medication use, which are assumed to be related to outcomes.