Can we measure quality using outcomes?

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Category : Medical Rants

 

Solo Dr writes:

In my area, quality doctors, according to hospital administrtors and other doctors, are the ones who make lots of money by seeing 40+ patients a day and doing lots of procedures to make the hospitals wealthy. I personally don’t see the conveyer belt medicine helping patients in the long term. I also find that my capitated colleagus are good at talking healthy patients out of screening colonosocpy after age 70 and are good at pushing the sickest patients onto other doctors to keep their efficiency and quality ratings high.
 

Quality should not be measured in time but on outcomes. Providing rapid short visits has a risk of the doctor missing things. Only the large items will be addressed at each visit, max 1-3 things per visit and times is up.

Outcomes are the holy grail, but like the holy grail elusive.  Here is the problem.  If you want to measure my quality you must measure outcomes for all my patients.  And you must measure outcome rather than process indicators.  We have too many examples of logical process indicators failing or leading to harm.

How do you measure outcomes when our goals differ so greatly with each patient?  Some patients present a diagnostic problem.  Some require chronic management of one problem.  Some require juggling 6 problems.  Some patients come for a routine check up.  What parameters should we measure?

We should not provide quality measures using only a minority of patients.  We definitely should not provide quality measures which encourage us to select patients (cherry pick.) 

Having done "outcomes" research, I believe that such research can provide interesting information for improving practice, but not for judging or ranking physicians.

My point from the previous post is that our current payment system detracts from quality.  The mere existence of our coding discourages spending appropriate time with patients.

Comments (3)

In the instance of lymphoma patients there are some who feel like the payment system causes Oncologists to underuse very effective drugs that require referring a patient to a Radiologist for administration.

i don’t view it as a conscious decision by the Oncologist, more that they stick with what they know.

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