Published in the September 2006 issue of Today’s Hospitalist
For years, physicians have grumbled that the quality improvement measures being given such a high profile by payers like Medicare are putting too much focus on a fairly narrow range of conditions. As two stories in this issue point out, early data suggest how that narrow focus may skew clinical practice.
The goal of giving pneumonia patients antibiotics within four hours of their arrival at the hospital is a good example. While there’s plenty of solid evidence that early antibiotics help reduce mortality, a new study finds that rushing to antibiotics may mean that the drugs are being given inappropriately.
In the hyper-competitive environment that makes up American medicine, most hospitals are working hard to be No. 1 on quality measures. That means getting antibiotics to 100 percent of their pneumonia patients within four hours, not 75 percent or 80 percent or even 90 percent.
That drive to come out on top of the quality measures being implemented by Medicare may also be causing a kind of tunnel vision that hurts other areas of patient care. Another study profiled in this issue found that care for chronic obstructive pulmonary disease (COPD) often doesn’t follow well-established guidelines. One theory is that the quality improvement community has poured so much energy into measures for conditions like pneumonia that other disease states “even major ones like COPD “don’t get the kind of attention to best practices that they deserve.
All of this isn’t to say that quality measures are bad and should be abandoned. The researcher who uncovered the problems with COPD care, in fact, says that in many ways, quality measures and the public reporting of data are still our best shot to improve care.
Nonetheless, these new data paint a startling picture of how quality measures may be slowly “and insidiously “changing health care. As Medicare expands the number of quality measures for reporting, physicians should consider these data a sign of things to come.
Editor and Publisher