Do performance indicators make a difference?

Background: The Maryland Hospital Association, Inc (MHA) Quality Indicator (QI) Project(R), a program of indicator development and application, includes more than 1,100 participating hospitals. Access to data is limited to participants to promote improvement through comparison across hospitals. Participating hospitals have identified and acted on opportunities for improvement in information systems, communication across departments of appropriateness of practice, and improvement ''beyond the hospital door''. Case study 1: Two teams were formed to address waiting time in the emergency department and failure of patients to find treatment. Improvements, including rapid modification of available inpatient beds, additional staffing during high-census periods, and streamlined processes for lab work and imaging turnaround times, were followed by better indicator performance. ase study 2: A hospital discovered three causes for a high rate of unscheduled admissions following ambulatory surgery. Interventions included extending the hours of the Same Day Surgery Unit (to solve a urination problem) and changing the anesthesia used (to reduce nausea and vomiting). Case Study 4: To successfully bring its cesarean section (C-section) rate down closer to the statewide rate, one hospital had physicians encourage patients with previous C-sections to undergo a trial of labor, promoted the use packaging to facilitate the use of prostaglandin gel to induce cervical dilation. Conclusions: The QI Project(R) continues to deal with issue concerning quality of data versus quality of care, the correlation between indicator rates and care processes, and the usefulness of severity adjustment.