Regarding “
Greater scrutiny of quality process measures urged”:
The Joint Commission is on a confused track. Mark Chassin's study of his organization's quality process measures was interesting to those of us who find “process” measures typically indirect, microfocused and therefore misguided as an approach to improving quality. While the criteria he used to evaluate the measures seem to make sense on the surface, let's take a step back and ask what the heck we're trying to do, anyway—i.e., improve healthcare quality—and are process measures the way to do this?
First, the good news: Some of the process care measures seem useful—if caregivers do these things, the outcome will be better. Early intervention with blood thinners for heart attacks is a good example. Administering blood thinners as early as is practical, with today's technology, is an unambiguously good idea, so that's a good one, I guess. Percutaneous coronary intervention within 90 minutes? Sure seems like the right thing right now, again, with today's technology. OK, we have two good measures covering what, 1% of all inpatient cases?
Now for the bad news: There are a lot of things that aren't heart attacks. Only one other measure for doing something quickly has been identified: in this case “Initial antibiotics within six hours” for pneumonia. Other process-of-care measures are the bare-bones basics—“appropriate initial antibiotic” or “assessment of left ventricular systolic function.” Can this possibly be an effective documentation task? Not much meat on these bones to my eye.
And then you get to Surgical Infection Prevention. Seems to me that actually measuring surgical infections, as AHRQ measures do, without any additional documentation burden, I might add, is the way to get at performance issues on this one. Tracking “Hair removed using safe method—pre-surgical,” “Prophylaxis antibiotic—right kind,” and “Prophylaxis antibiotic stopped within 24 hours” seem more than basic, unspecific in their measurements, and yet inflexibly tied to current practice methods. So to my way of thinking, the Joint Commission-directed study does little more than confirm it likes its own measures, and will continue to burden the industry with these measures, given its power position in the accreditation process. Urging greater scrutiny of quality process measures is definitely the right idea. Chassin's study seems to just smooth over the basic problem with the whole approach—meanwhile public data and other pathways become stronger and are leaving the commission's approach in the dust.
Thomas Day
President
Healthcare Management Council
Needham, Mass.
