We have noted that poorly constructed “quality measures” often fail to induce the provision of higher quality health care, and in some cases may even lead to interventions that harm patients, waste resources, and/or contribute to clinician burnout.
We therefore endeavored to develop a system for evaluating quality measures in the hope of “retiring” poor measures and providing a guide to the creation of a newer generation of clinical quality measures which might better fulfill the goals of quality measurement. In some cases, quality should be measured to inform quality improvement (QI) activities. In other situations, people are interested in evaluating the quality of care provided to make judgments about providers or to award (or reduce) payment. Though evidence for the utility and value of pay-for-performance (P4P) is lacking, we believe both have their role.
Ultimately, however we would like to see quality of care assessed in ways that allow for improvements that produce better health care and better health for patients regarding outcomes that matter to them: primarily improved quality of life, extended quantity of life, and/or reduced expenses.
While some measures, especially during a phase of testing and development, might be appropriately used for QI activities, we believe that before a measure should be implemented in ways that include accountability (e.g., public reporting or P4P programs) however, the measure should be shown to have passed a more rigorous set of criteria.
Accordingly, members of Care that Mattersand editors of DynaMed Plus[link]have collaborated to produce a set of 10 criteria by which the appropriateness of quality measures should be judged. This process evolved over many months and included “field-testing” of the criteria against numerous quality measures as evaluated by many physicians.
Now that we have developed and tested the criteria, we have begun the process of systematically reviewing commonly used quality measures, and we hope to publish the results soon. (Preview: many will be deemed inappropriate.)
Ronald Adler, Wayne Altman, and Alicia Agnoli
Brian Alper, MD, MSPH, FAAFP, Founder of DynaMed and Vice President of Innovations and Evidence-Based Medicine Development, EBSCO Health; Alan Drabkin MD, FAAFP, Family Medicine Section Editor, Assistant Professor Harvard Medical School; and Alan Ehrlich MD