The fundamental purpose of healthcare is to achieve good health outcomes for patients (Murphy, 2012). Clinical outcomes are measured and published to ultimately improve healthcare quality for individuals. The role of performance measurement in healthcare is thought to ensure a minimum standard of care for patients (Kiernan & Buggy, 2015). However, there are some concerns regarding the costs of data collection for measuring such performance, specifically in regards to anesthesia services. Much of the hesitation regarding healthcare performance measurement of anesthesiologists, CRNAs and other healthcare providers pertains to the idea that large amounts of high quality data cannot be accurately collected for national comparison, which can lead to flawed analyses or data misrepresentation. The inability to accurately and uniformly capture health outcomes for patients undergoing anesthesia services, along with misrepresentation and other blatant misuses of data are a few of many costs of data collection for measuring healthcare performance. Additionally, clinicians and researchers are often unable to provide individuals the appropriate context to interpret information collected from such measures. This leads to an information discrepancy in healthcare performance measurement that leaves patients unable to distinguish between relevant and irrelevant information, adversely affecting professional healthcare provider attitudes and patient-doctor relationships (Kiernan & Buggy, 2015).
Anesthesiologists and CRNAs provide intricate anesthesia services to complex patients, and while recent technological advances have facilitated the ability to collect procedural data, there is little information on the effects of patient health outcomes following the use of anesthesia services. Measuring such outcomes is problematic in that modern anesthesia is a relatively safe practice, so the variable of mortality is not a particularly sensitive quality indicator for evaluating healthcare outcomes. Further, there is not yet an established consensus on how to measure perioperative anesthesia-related mortality; its definition ranges from death within 48 hours of an anesthesia procedure, to within 30 days. Researchers are currently focusing on defining the current use of quality measures in anesthesia practice to identify areas of need, and develop new measures to ultimately alleviate such costs of healthcare performance measurement for anesthesia services. While the healthcare system should be committed to a culture of accountability and transparency, efficient data collection should accurately reflect performance, be specifically targeted to anesthesia services performed by anesthesiologists and CRNAs, and be disseminated to patients as it applies to their care, and with ample context provided for explanatory purposes. The ultimate challenge for anesthesiologists, CRNAs and others involved in providing anesthesia services will be to define, identify and agree which quality indicators should be collected nationally, to determine the most efficient and effective means of care in terms of cost, risk and health outcomes for patients (Murphy, 2012).
F. Kiernan, D. J. Buggy; What’s measured matters: measuring performance in anaesthesia. Br J Anaesth 2015; 114 (6): 869-871. doi: 10.1093/bja/aev102
P. J. Murphy; Measuring and recording outcome. Br J Anaesth 2012; 109 (1): 92-98. doi: 10.1093/bja/aes180