Considerations in the development of intensive care unit report cards

Concerns over health care quality have prompted calls for the public release of performance data, or "report cards," as one strategy for improving quality. Any initiative to create a report card should start with the selection of valid quality indicators. Tills is complicated by the need to account for variations in case mix among intensive care units (ICUs), the difficulty in defining which patients are receiving critical care, and the fact that pre-ICU and post-ICU care can influence the outcomes of care for ICU patients. The difficulties in measuring quality accurately make some providers reluctant to release performance data to the public, but advocates of public disclosure point to examples of improved quality after publication of report cards. Consumer and purchaser demand for report cards continues to increase, so public reporting of performance data likely will become more common. In light of this trend, it is important for physicians to become involved in the development of report cards to ensure that quality measurement is valid and that the data are used for quality improvement.