Quality Measures Flashcards
Process-level quality
Ex, what percentage of patients who were eligible for a flu shot got one?
Outcome-level quality
Ex, what is the mortality rate from x condition at this hospital?
Patient-experience level quality
Ex, how did the patient rate their satisfaction with the care they received?
Structural-level quality
Ex, does a hospital have a NICU?
What makes a good quality measure?
- Good scientific evidence
- Feasibility of measurement
- Importance of measure
- Meaningful estimate of impact from adherance to measures
Single measures
Measuring a single statistic as a means of evaluating quality
Composite measures
Compositing multiple single measures into a composite “score” which is used to grade quality
Often “all or none” measures
Change measures
Highly outcome-based quality measures that grade based on the quantifiable change in risk or prior probability of disease in patient populations
Where we ultimately want to be, but we aren’t there yet
ProPublica’s transparency initiative
“Dollars to Docs”
It is a service which promotes transparency in medicine by disclosing information like payment of physicians (for example, your physician got $1000 from industry last year), complication rates, etc. Often these are difficult for laypeople to interpret, so ProPublica also does some statistical analysis (for example, your surgeon’s complication rate is higher than the national average).
Medical community’s reaction to the sudden shift in transparency
Physicians immediately rose two concerns:
- insurance claims data are notoriously inaccurate, particularly when it comes to assessing surgical complications (they often use proxy measures or measure complications which may result from patient nonadherence, which is not something a surgeon, for example, controls)
- sample size: A given surgeon may perform too few surgeries of a specific type in a given year to accurately assess where he falls on a national ranking, especially given differences in patient population
RAND scientist Mark Friedberg in response to ProPublica’s data
“With confidence intervals like these, who needs enemies?”
ProPublica has widely been accused of ___ in it’s promotion of its new analysis tool.
ProPublica has widely been accused of sensationalism in it’s promotion of its new analysis tool.
Saurabh Jha’s hidden metric that most economists miss or dismiss
Professional pride
What is a patient vs a physician likely to do when they are looking for a good orthopedic surgeon in another city?
Patients will utilize whatever professional rating systems they can find
Physicians will call a colleague in the area and ask who is good
It is a common lament among physicians that: “The best surgeon I know has . . .”
It is a common lament among physicians that: “The best surgeon I know has the highest complication rates.”
