Epidemiologic approaches to quality assessment.

Hospital epidemiologists have an opportunity to apply their skills to hospital quality problems other than infection control. Soon, hospitals will be required to collect and report numerous quality indicators, whose results will require epidemiol gic interpretation. For those who choose to make transition into quality management, careful assessment and planning are needed to succeed (Infect Control Hosp Epidem ol 1995;16:101-104) . INTRODUCTION: THE OPPORTUNITY Infection is only one of many adverse events that may occur to hospitalized patients. The majority of adverse events are not related to infection (Table 1), but nonetheless are amenable to study by the same epidemiologic techniques used for infection control. In fact, due in part to the success of nosocomial infection control, study of other adverse events has assumed greater importance than infection control in recent debates about healthcare quality. It is clear that someone in each health institution will be performing epidemiologic assessments of many noninfection adverse events before the end of the 1990s. The crucial question is whether those with skills in infection control epidemiology will expand into these new areas of hospital epidemiology, or instead will work for someone who does. In order to study any event epidemiologically, one needs to develop case definitions and perform surveillance.)-2 Most infection control practitioners feel very comfortable defining nosocomial infection events. Developing such definitions for other adverse events may be quite difficult, especially if one wants to account properly for associated risk factors. For example, what risk factors need to be collected to develop a fair comparison among providers and hospitals of rates of falls? Fortunately, expert panels at the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) are developing quality indicators using a rigorous scientific process.3 These indicators ar in ended to track precisely defined events that provide clues to pati nt care quality. More than 50 such indica ors are under study by JCAHO. By 1997, it is expected that all hospitals seeking JCAHO accreditation will b r quired to collect and report the first set of ind cators; soon thereafter, results will be returned o your hospital. Who in your institution will be asked to review these results and, perhaps, to explain why rates of some adverse events are elevated? Certainly, such persons will need epidemiologic skills if they are to perform an accurate, fair investigation. Accreditation of the institution or credentialing of practitioners may depend on the results of an investigation. Because JCAHO expects indicator results to be public information, your institution and practitioners may find themselves compared with other institutions and practitioners in the local paper. The pressure to "look good" on these reports will be substantial. Thus, those who possess epidemiologic skills, who can perform a valid clinical study and produce reliable results, should be in great demand. JCAHO will not be the only source of quality management surveillance data. The Health Care Financing Administration is beginning an initiative through From the Methodist Hospitals of Memphis (Dr Simmons), University of Tennessee, Department of Preventive Medicine (Drs. Simmons and Kritchevsky), Memphis, Tennessee. Address reprint requests to Bryan P. Simmons, MD, 188 South Bellevue, Suite 419, Doctors Building, Memphis, TN 38104. 94-SX-189. Simmons BP Kritchevsky SB. Epidemiologic approaches to quality assessment. Infect Control Hosp Epidemiol 1995;16:101-104. This content downloaded from 157.55.39.207 on Thu, 20 Oct 2016 04:12:33 UTC All use subject to http://about.jstor.org/terms 102 INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY February 1995