Abstract
* Abbreviations: OBS — : observation status RA-LOS — : risk-adjusted geometric mean length of stay The underlying vision for pediatric quality measurement is improved care and health outcomes for children. Quality measures help realize this vision, through capturing system successes and failures in supporting child health. There are a large number of quality measures, some of which are focused on processes, some on outcomes, and some on use.1 To accurately assess successes and failures in care delivery, measure design matters. This is because measures can deeply incentivize behavior because of their use in reputational (eg, public reporting) and financial incentive (value-based purchasing) programs. In this issue of Pediatrics , Gay et al2 focus on risk-adjusted geometric mean length of stay (RA-LOS), a commonly used metric for understanding hospital use. Hospitals and payers often use this to assess efficiency and throughput, with the most familiar manifestation being the focus on “discharge before noon.” But increased RA-LOS can also signal issues with patient safety and increased hospital-acquired conditions.3,4 Hence, getting this measure design right is important because the measure informs hospitals not only about their relative efficiency and throughput compared with other hospitals nationally but also about potentially important failures in patient safety. Ga2y et al2 focus on a specific … Address correspondence to Naomi S. Bardach, MD, MAS, Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 3333 California St, Suite 265, San Francisco, CA 94118. E-mail: naomi.bardach{at}ucsf.edu
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