Quality – the number one issue


Category : General, Medical Rants

In recent meetings with several internal medicine leaders, it became apparent that quality was the current buzzword. Quality measures will soon lead to pay for performance. I have recently ranted on this subject – Concern over pay for performance.

Despite our concerns, the train is chugging down the track – and physicians do not seem to be on board yet – Most doctors slow to integrate quality data into their practices

A survey of 1,837 physicians by the Commonwealth Fund showed that only one in three doctors has access to data about the quality of their clinical performances and one in three is involved in redesigning their systems to improve care.

Researchers said physicians are slow to adopt measures to boost quality and doctors are reluctant to publicly share information about the quality of care they provide.

“It’s fine to have [quality] data but you have to integrate it in your daily routine,” said Anne-Marie Audet, MD, vice president of the quality improvement program at the Commonwealth Fund and lead author of the study, which appeared in the May/June Health Affairs.

As one involved in quality research, I worry about how we measure quality. Some measures make sense. We (and others) do have data showing that patients who receive higher quality care have better outcomes (for some problems).

The problem here is that we are only measuring a small piece of pie. Being a physician requires more than meeting quality measures. Where is the quality measure for taking a good history, or doing an appropriate physical examination? Where is the quality measure for ordering the right tests and not too many expensive tests? Where is the quality measure for spending time with the patient – improving her quality of life because we asked the right questions and improved medication adherence?

I favor practices working to improve their quality of care. However, I hope we understand that quality measures, while accurate and convenient are incomplete. So embrace quality, yet continue to make the case for quality measures being a partial measure of our competency.

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Comments (2)

Regarding quality: this is big in the UK where I work. Unfortunately, quantity is easier to measure than quality, and inappropriate measures of quality (such as “time to discharge from ER”) are driving clinical practice right now. My wife is doing a high-quality MS in quality improvement in clinical practice so at least one of us will profit from the ever-burgeoning bureaucracy. Seriously though, this MS run by the University of Swansea is targetted at administrators and teaches them about epidemiological methods, economic analysis and other areas which should raise the quality of quality initiatives.

The problem I see with analyses of quality, with the plan to implement changes starts with quality really being a nebulous entity.
So we measure epiphenomena of quality, then implement those epiphenomena and calling that an improvement.

It would be something like analyzing the motions of a great actor, imitating them, then saying, “Now I too am a great actor!”

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