Performance management using health outcomes: in search of instrumentality.

The past decade has seen the growing use of performance data in the hope of bringing about quality improvements in health care. Most recently, an emphasis on health outcomes (and especially mortality rates) has led to much activity around collecting and publishing such data. Two major problems intervene. What meanings can be ascribed to reported health outcomes? And what impacts are they likely to have on clinical performance? Much empirical work supports the assertion that reported outcomes may be poor indicators of service quality. In addition, the impact of these data may be small or even detrimental unless great care is made to connect the reporting with explicit quality-improving actions.