Application of severity measurement systems for hospital quality measurement

As hospitals increasingly emphasize efforts to measure and improve quality of care, the related issue of severity measurement emerges as a topic of strong interest. Severity measures can support hospital quality management in at least two areas: selection of medical records for individual case review and monitoring of patterns of care including analysis of rates of adverse outcomes. Some systems currently available for measuring the severity of general medical and surgical admissions in acute care hospitals base severity scores on data available in computerized discharge abstracts, while others use detailed clinical data abstracted directly from patient medical records. One is based on both detailed medical record data and International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) diagnosis codes. This article discusses issues important to the definition and measurement of patient severity and examines the strengths and limitations of specific systems and their potential contributions to quality management.