Key Concepts

• The Donabedian structure/process/outcomes model is a useful paradigm for categorizing and conceptualizing different approaches to measuring quality.
• Process measures are preferable to outcome measures when there is clear evidence supporting a particular clinical activity and when there is a related gap in care delivery.
• Outcome measures are highly valid, but often do not generate a clear path for quality improvement; they are most useful in situations of high complexity where clear standards are not well established.
• Administrative data and registry data can yield very different measurements of quality, and leaders in surgical quality should be familiar with the strengths and weaknesses of these two types of data.
• A broad range of nontraditional measurements of quality are on the horizon, including patient-reported outcomes, patient satisfaction, and return to health.
• Accreditation programs such as the National Accreditation Program for Rectal Cancer (NAPRC) have an important potential role in improving quality of care by improving the structure of care delivery throughout the country.