Health Care Quality Measurement needs Reimagining

Reimagining Quality Measurement — NEJM

The quality-measurement enterprise in U.S. health care is troubled. Physicians, hospitals, and health plans view measurement as burdensome, expensive, inaccurate, and indifferent to the complexity of care delivery. Patients and their caregivers believe that performance reporting misses what matters most to them and fails to deliver the
information they need to make good decisions. In an attempt to overcome these troubles, measure developers are creating ever more measures, and payers are requiring their use in more settings and tying larger financial rewards or penalties to performance.

We believe that doing more of the same is misguided: the time has come to reimagine quality measurement. A fruitful alternative approach, in our view, would be guided by three principles:

1. quality measurement should be integrated
   with care delivery rather than existing as a parallel, separate
   enterprise; 
2. it should acknowledge and address the challenges that
   confront doctors every day
1. common and uncommon diseases, 
2. patients with
   multiple coexisting illnesses, and 
3. efficient management of symptoms
   even when diagnosis is uncertain; and 
3. it should reflect individual
   patients' preferences and goals for treatment and health outcomes and
4.  enable ongoing development of evidence on treatment heterogeneity.1

JAMA Network | JAMA | Patient-Centered Performance Management:  Enhancing Value for Patients and Health Care Systems

All too often, the US health care system fails patients at 2 levels.

• Some patients fail to receive care that would clearly help them, whereas
• other patients receive care that will not benefit them (and may even be harmful).^1,2
  
• Worse, clinicians also might fail to inform patients about the risks and benefits they might incur from even simple and common treatments.
• Instead, the current focus on one-size-fits-all guidelines and  performance measures (eg, all patients should achieve a specified blood pressure [BP] threshold) discounts key commitments to personalizing care based on individual risks and preferences, even to the point of  promoting unnecessary and harmful treatment.^3,4