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Quality Measures: More Harm Than Good?

Numbers don’t always tell the whole story

Certain patient safety efforts look better on paper than they do when put into practice. Quality measures are a big deal these days, and for good reason. They are designed to protect patients. The question is, can some of these “standards” cause more harm than good?

What are quality measures?

Basically, quality measures are standards that hospitals aim to reach—it’s a way for hospitals to report numbers like mortality or whether they give patients the correct medicines. The idea is that these quality measures protect patients and improve outcomes because everyone’s “watching the numbers.” But the numbers don’t always tell the whole story.

Quality measures are an important focus at hospitals everywhere, including Cleveland Clinic, where Umesh N. Khot, MD, serves as Chief Quality Officer for Cardiovascular Medicine. “Now more than ever, medical institutions are heavily focused on quality measures,” he says.

“There has been a proliferation of quality measures that have been introduced, and while we think these measures seem reasonable to implement and are in the best interest of patients, we are finding that these measures are not one-dimensional,” Dr. Khot says.

When can quality measures go wrong?

Take mortality rates for high-risk patients. A commentary published by Dr. Khot in the Journal of the American College of Cardiology (JACC) shares how high-risk patients in Massachusetts were being denied life-saving surgery to improve the mortality (death) rate for a heart procedure. Rather than report another death, the physicians and hospital would rather not do the surgery on a patient who was higher risk than average.

Another example: To show that fewer people have deep venous thrombosis (DVT), important diagnostic tests such as ultrasound were being discouraged at certain medical centers. Sure, the results on paper looked better: less occurrence. But is the hospital looking hard enough for the condition?

The verdict on quality measures

Quality measures are a good thing. But it’s important for hospitals to look at quality measures carefully from every angle. The ultimate goal is to improve patient safety—and when the numbers become more important than a hospital’s mission, that’s a problem. No piece of the patient care puzzle can be left out of the puzzle when creating quality measures.

“As a general rule, it is our mission to take care of the very sick, but we are coming under the same pressures as everyone else with increased monitoring,” Dr. Khot says. “As physicians, the challenge is to identify which quality measures will lead to true improvement.”

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