1 - Eulogy for a Quality Measure
Dr. Thomas Lee writes in the New England Journal of Medicine:
On May 8, 2007, one of the best-known quality measures in health care was put to rest. The percentage of patients with acute myocardial infarction who receive a prescription for beta-blockers within 7 days of hospital discharge has been used to evaluate U.S. managed care plans since 1996. This measure will no longer be reported by the National Committee for Quality Assurance (NCQA) because it is simply no longer needed — a development that offers encouragement and important lessons.
The data in the graph show why the NCQA Committee on Performance Measurement voted unanimously to retire the beta-blocker measure. A . . .
Sorry, extract only without paying a fee -- but here are the next couple of sentences:
. . . decade ago, only two thirds of US patients who survived acute myocardial infarctions recieved beta-blockers; today, nearly all do. As the curve representing the 10th percentile crept above 90%, the NCQA found little variation among health plans. At least when it comes to this intervention, the U.S. health care system has become reliable.
2 - Mashup Request
Bob Coffield's excellent Health Care Law Blog had an interesting piece this past weekend citing NetDoc's mashup of HHS hospital data -- heart attacks, heart failure, pneumonia, surgical infection prevention -- with Google maps. Note the following thoughtful comment from Bonnie on this entry:
This is a very smart idea! Next, I want to see a mashup that shows hospitals within a certain region that exhibit the best infection control rates.
Well, maybe not Bonnie! After all, the site itself warns:
Important: This tool should not be used to make medical decisions - check the original data source (HHS Hospital Search) and discuss hospital options with your physician to select the best hospital for you. Neither hospital locations nor the accuracy of the rankings/data shown is guaranteed, and there may be errors and/or ommissions (sic).
3 - Does Disclosure Hurt Minorities?
Finally, a 2004 article in Circulation entitled "Racial Profiling,The Unintended Consequences of Coronary Artery Bypass Graft Report Cards," by Rachel M. Werner, MD, PhD; David A. Asch, MD, MBA; Daniel Polsky, PhD suggests:
Although public release of quality information through report cards is intended to improve health care, there may be unintended consequences of report cards, such as physicians avoiding high-risk patients to improve their ratings. If physicians believe that racial and ethnic minorities are at higher risk for poor outcomes, report cards could worsen existing racial and ethnic disparities in health care.
A similar conclusion was reiterated by a couple of the authors the next year:
Public reporting of quality information promotes a spirit of openness that may be valuable for enhancing trust of the health professions, but its ability to improve health remains undemonstrated, and public reporting may inadvertently reduce, rather than improve, quality. Given these limitations, it may be necessary to reassess the role of public quality reporting in quality improvement.
As arguments about disclosure start to be more vigorous here in Massachusetts, the first article is finding its way around the halls of government. Does anyone know if these same authors have updated their findings since 2005, or if there have been further articles by others on this subject?