The Quality of Measuring Quality

As quality and safety advocates, we ask the questions: “How are we doing?” and “How can we be better?” While we are constantly improving the day-to-day work in our own departments, do we ask these same questions of the larger quality movement, in general? In her opinion piece published in April 2022 in the New England Journal of Medicine, Dr. Lisa Rosenbaum explores the current state of our country’s quality improvement model. She questions the effectiveness of some measures and calls out the increased administrative toll these measures place on clinicians. Furthermore, as quality experts, we strive to provide high quality care at a low cost, i.e.: high value care.  However, as we aim to measure care and tie financial incentives to these measures, an entire industry is growing to help physicians and hospitals capture these incentives.  This begets the question, does tying quality measures to reimbursement actually add value to the healthcare system? Or are we simply shuffling money around as more is spent to hire outside consultants? For all the improvement that we’re seeing – such as substantial advancements in opioid prescribing practices or care delivery for patients with heart failure – our system tends to reward “high performing” organizations who may know how to make the numbers look good. Furthermore, as our body of scientific knowledge continues to evolve, how easy will it be to adapt our practice to incorporate this new knowledge? Or how do we acknowledge unforeseen circumstances such as a global pandemic or shortages of drugs, iodinated contrast, or baby formula?  Perhaps the best answer is helping health systems, departments, and physician practices create a culture of safety and sustainable QI project teams that can easily interpret, adapt, and disseminate knowledge to their teams and communities. I encourage all of you to review Dr. Rosenbaum's paper and I welcome any feedback or thoughts. 

Rosenbaum, L. (2022). Reassessing quality assessment — the flawed system for fixing a flawed system. New England Journal of Medicine, 386(17), 1663–1667. https://doi.org/10.1056/nejmms2200976

Best,
Clint Hobson, MD, MAS

QIPS Newsletter Editor