All they do is drive physicians to practice to meet numbers whether or not they make clinical sense.

it seems your rant is really about efficacy vs. effectiveness on one hand, and the ever changing world of medical knowledge on the other.

Of course medical knowledge changes, as you point out with beta blockers, estrogen, etc. that doesn’t say much about whether p4p guidelines are good or not, it just says they need to be flexible and able to change with our knowledge.

The efficacy vs. effectiveness argument is more compelling and gets to the heart of the matter. Are carefully controlled trials in selected populations a sound foundation for designing guidelines applied to the population as a whole? How much do we trust a trials’ design and results, especially when sponsored? Were unintended consequences properly considered? How important is the clinical benefit in the trial? How does my patient differ from those studied in the trial? How do I include patient preferences and values in the discussion? What do I prioritize if there are several guidelines to consider?

These are complex decisons to be made at the individual patient level. There may be algorithm basesd guidelines for diseases, but there are none for patients, which is why it’s called the art of medicine.

The indicators themselves have no impact on patient care. It’s their use that has an impact. Clearer language produces clearer thoughts.

On this whole 4-hour antibiotic timing thing, the published literature don’t paint a clear picture of effects on patient care, for better or worse.