For what should hospitals be accountable?

BACKGROUND: An underlying assumption in discussing for what hospitals should be accountable is that the public trusts that hospitals will act in patients' best interests. Therefore, hospitals must be accountable to demonstrate that they deliver high-quality care. They must also demonstrate that they are doing so as efficiently as possible for the patients of public payers (and others). ISSUES: Current mechanisms for public accountability are neither comprehensive nor do they incorporate a systematic approach for ensuring that hospitals deliver high-quality care. Current efforts to establish which information is helpful for monitoring the quality of hospital care are duplicative and incomplete. In addition, many current approaches are not reliable or valid; there is no routine mechanism for evaluating reliability and validity of data released to the public. CONCLUSION: Recommendations are made regarding what kinds of information hospitals should be required to give to federal agencies. A federally organized effort is needed to develop standard quality measures, as well as specification of the state or other agencies that should be required to monitor the quality of hospital care for all patients and of the requirements for ongoing evaluation of the reliability and validity of the data used to assess quality of care. Changes in policy are suggested that would facilitate a federal effort to develop and maintain standard quality measures.