There is a fantastic editorial in the October 15, 2014 issue of the Journal of the American Medical Association (JAMA) entitled, “ What Makes a Good Quality Measure?”
Drs Elizabeth McGlynn and John Adams from the Kaiser Permanente Center for Effectiveness and Safety Research wrote an editorial associated with two original research article also in the same issue. The two research articles are on the correlation between quality measures and healthcare outcomes. The first article found that there was no correlation between obstetric quality measures related to labor and delivery and the health outcomes of the mom or the baby. The second article found that there was not a consistent correlation between quality measures for skilled nursing facilities and outcomes as measured by readmissions to the hospital and death.
In short, better performance on the quality metric did not translate into a better outcome. Worse performance on the quality metric did not translate into a worse outcome.
In other words, maybe the quality metric was not relevant.
This is an important point that Drs. McGlynn and Adams discuss in their piece. In this day where terms like ‘quality’ are thrown around left and right, what does the word really mean. The answer is potentially… not much.
The authors then lay out a framework for correlating a ‘quality measure’ with outcomes. They write, (1) is the quality measure even related to the outcome, (2) is the magnitude of the relationship even relevant and (3) is the outcome significantly impacted (similar to #2, but has some nuanced differences).
The authors conclude their editorial with the capstone sentence, “Both reports make it clear that a great deal of additional work is needed to achieve the quality measures necessary for a more complete characterization of system performance and potential improvement opportunities.”
Bravo to them for being honest and saying, in effect, “We don’t know.” Keep in mind this editorial is coming from Kaiser and has passed the review board of one of the most well respected medical journals in the world.
What does this mean for employee benefits professionals and healthcare consumers:
- Any claims or data related to ‘quality metrics’ needs to be taken with a grain of salt.
- The quest for ‘quality metrics’ is still a warranted one. Just because we have not reached the mountain top, does not mean we as a profession should not stop trying.
To see how Compass helps employers and employees in this world of healthcare uncertainty, click on the 5-min video below?