Moving Toward Better Measures 

Abstract

In the early 20th century, Massachusetts-based surgeon Ernest Codman advocated for the widespread measurement of outcomes. He believed surgeons should keep track of their outcomes and examine how these outcomes were related to the care they provided. Anticipating future trends, he argued that these measures be used both for improvement—so individuals could learn what worked —and for accountability (eg, as the principle criteria for hospital appointment or academic advancement).

Quality measurement is not new in pediatrics either. Clinical study groups, such as the Children’s Oncology Group, have long examined outcomes such as mortality and used them to guide revision of protocols. The Centers for Disease Control and Prevention standardized the measurement of immunizations in the AFIX program, enabling pediatricians to examine their performance against standards and track improvement. Numerous reviews have cataloged and categorized the available performance measures.