Table 1.

Categories and examples of performance measures used in public reporting programs

Measures	Examples	Advantages	Disadvantages
Structural	Use of an EMR	Easy to measure	Limited correlation with quality of care or outcomes
	Nurse/patient ratio		Rarely actionable
Process	Use of perioperative antibiotics	Easy to measure	Limited clinical relevance
	Surgical site marking	Evidence-based	Limited correlation with quality of care or outcomes
	Postoperative VTE prophylaxis	Guide manageable change
Outcome	Health-related quality of life	Most relevant measure of quality	Difficult to measure
	Infection rate		Time-intensive, expensive
	Dislocation rate		Require risk adjustment
	Readmission rate		Time lag between intervention and outcome make real-time reporting impossible
	Reoperation rate		Reflection of cumulative impact of multiple processes so isolation of variable to change is often difficult
Patient experience	Patient satisfaction, experience surveys	Patient-centered	Dependent on patient expectations and sociodemographic characteristics
		Measurable	Dependent on alternatives
			May not correlate with quality of care or clinical outcomes
			Influenced by multiple processes so isolation of variable to change is often difficult
Efficiency	Episode of care costs	Easy to measure	Standards are not well established
	Use of surgical services	Comparative across practices	Require risk adjustment
	Use of injections, physical therapy		No correlation with quality of care, patient outcomes, or cost-effectiveness

Modified and reprinted from Bozic KJ, Smith AR, Mauerhan DR, Pay-for-performance in orthopedics: implications for clinical practice, Pages 8–12, Copyright 2007, with permission from Elsevier. EMR = Electronic Medical Record; VTE = venous thromboembolism.