How do you measure the severity of an illness or injury? The focus on using quantifiable measures in evaluating the quality and costs of patient care makes answering this question imperative. Alemi and Walters present a mathematical model for identifying and measuring the severity of episodes of care. Among the advantages claimed for their approach is that it can be implemented on most databases and can be used to construct measures of episodes for diverse diseases and different service locations. In their article, the authors discuss the mathematical theory underlying their proposal to construct episodes of care and to quantify their severity.

While health care quality researchers agree that hospital readmission rates are a useful tool in evaluating the outcomes of care, they do not all agree on how to define readmission. As Landrum and Weinrich point out in "Readmission Data for Outcomes Measurement: Identifying and Strengthening the Empirical Base," the literature is short on precise definitions and precise, quantifiable parameters of readmission. They discuss the damaging impact of the varying definitions on efforts to develop objective measures of comparisons for use in evaluating institutional performance. The authors analyze the concept of readmission and create a criteria-based definition of the term. Following up on this process, they propose to introduce an objective measurement instrument for use in quantifying readmission in studies involving evaluation of patient care outcomes.

Cultural and gender stereotyping pop up in many situations and influence a variety of interactions. Sometimes they can lead to benign but basically sexist predictions of behavior. One example of this was the notion that the character or style of medical practice would become more patient-centered and "feminized" as the numbers of female physicians grew. Kinder, gentler doctors if you will. A corollary was that patient satisfaction with medical care would improve. Wolosin and Gesell set out to test this proposition. They report the findings from their study of gender differences in medical practice and the impact of the physician's gender on patient satisfaction levels.

On the heels of a year of disasters, Lynch and Cox explore the implementation of best practices by public health agencies. The British Columbia Ministry of Health identifies Health Emergency Management as a core program within the public health arena. As a step in implementing this concept, the ministry's Population and Public Health Department sponsored a review of best practices in health emergency management in British Columbia. That effort was supplemented by a literature review of evidence-based best practices. As the authors argue, defining and establishing best practices is not enough. Governance and accountability mechanisms must also be in place to support best practices. Accordingly, they examine the organization of health services in British Columbia and the opportunity for the development of a framework for the core functions of a public health system. They point to the fact that emergencies are multitasking situations and that the management of an emergency is not a job for one person or one department.

Starting from the proposition that the quality of health care, whether in poor environments or in rich ones, is generally "poor at worst and varied at best,"1 Peabody cites some of the problems physicians perceive with the concept of measuring quality. The process is expensive. Using standardized quantitative measures seems demeaning to professionals. The financial, policy, and legal constraints imposed on medical practice do not guarantee better quality. Published research results often fail to address the complexities and ambiguities seen in actual medical practice. The whole idea of measuring and evaluating professional performance is undeniably threatening, not only to physicians but also to all professionals. Speaking from the standpoint of the medical practitioner, the author goes on to explore practical ways to deal with and resolve each of these issues in the interest of improving the process of evaluating health care quality.

Jean Gayton Carroll, PhD, Editor

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