Measuring Quality

By HL Admin posted 07-04-2016 18:44


March 19, 2016


John Brady, M.D.

Over the years, I have been told by many quality directors that we need to measure stuff.  “If you can’t measure it, then you can’t improve it.”  I would ask how knowing the average HGBA1C of the population translates into the overall health of the population (particularly keeping in mind the results of the ACCORD Trial).  I would ask if anyone truly believes that measuring the number of diabetics with a HGBA1C over 9 who are on insulin (assuming it should be 100%) would make a difference.  I would ask over and over if they believed that family medicine, based in relationships, is best measured by disease-based metrics. The answer I always received was that we need to measure something and if there are no great ways to measure family medicine, then this is at least a start.  After all, it is impossible to improve something unless you measure it.

Bob Berenson, who was nice enough to be one of the Keynote lecturers at IMPCamp in 2014, recently penned an article in JAMA which takes the notion of required measurement to task.  He points out that not only are the historical quotes regarding measurement and improvement false, but the constant driving toward measurement, particularly with the carrot and stick approach, will likely lead to poorer outcomes (and unhappier physicians).

So perhaps the pendulum is starting to swing back.  Most of the recent literature I have read on metrics and measurement agree that there are way to many metrics and that the drive to measure everything has totally gotten out of hand.  The AAFP has recently worked to decrease the number of different metrics we need to worry about (though their approach is flawed—see my comment after the article). The ABFM, along with the AAFP, has just launched the Prime Registry which will pull data straight out of your EMR to report on the many disease based metrics necessary to fulfill the flawed MACRA requirements while reporting out on some of the Starfield pillars (at minimum continuity and comprehensiveness).  So perhaps it will serve to both feed the metric beast and begin to better measure quality in primary care.

One of the main struggles and frustrations over the past decade was watching as the zeal to measure quality took over all aspects of the practice of medicine.  Maybe, just maybe, things are beginning to change.  Fingers crossed the pendulum continues to return to the middle.