As quality process measures become more widely used for accountability purposes such as accreditation and value-based purchasing, increased scrutiny is needed to ensure those measures adequately capture data and lead to better patient outcomes, according to a study in the June 23 issue of the
New England Journal of Medicine.
Led by Mark Chassin, president of the Joint Commission, the study's authors proposed four criteria for evaluating accountability measures that address processes of care. First, they argued, there must be a strong evidence base showing that the care processes being measured actually lead to better patient outcomes. In addition, they said, measures must capture whether the processes actually took place; they must address a process that is close to the desired patient outcome; and they must have little or no chance of adverse effects.
Of the Joint Commission's 28 core measures for 2010, 22 made the cut, Chassin said after a speech at the Joint Commission's Annual Conference on Quality and Patient Safety in Chicago. Measures that failed to meet the accountability criteria included one for adult smoking-cessation counseling and another for heart failure discharge instructions—measures Chassin referred to as “upstream” because they fail to capture whether the care process actually occurred.
Chassin also responded to a June 23 study in the Journal of the American Medical Association, which found scant evidence linking the Surgical Care Improvement Project, or SCIP, measures with improved infection prevention. Chassin disagreed, saying the study author's relied on administrative billing data for its analyses.
“I don't think that study will cause any more of a blip on the radar than any of the other studies that rely on that kind of available data, because it's not sufficient,” he said. “The evidence behind the SCIP measures is very good.”
