Comparing the quality of health care providers

This article introduces a new approach for evaluating the quality of health care providers, including an integrated solution to several problems that limit the usefulness of available methods. Our approach combines information from ail the quality indicators available for a provider (e.g., from other years, other patients, or other indicators for the same patients) to estimate more accurately the provider's previous or expected quality. The approach also provides an empirical basis for comparing and combining alternative quality indicators, thereby enabling policy makers to choose among potential indicators, explore the potential bias in alternative measures, and increase the value of quality measures for assessing and improving care. Using hospital care for elderly heart attack patients as an example, we demonstrate that these methods can be used to create reliable, precise predictions about provider quality. Comparing quality of care across providers may be far more feasible than many now believe.