The old adage of “you can't improve what you don't measure” may need replacing, because—according to a new report in the Journal of the American Medical Association—roughly 65% of all U.S. primary-care physicians work in practices that are too small to generate a large enough annual patient sample to reliably compare their practices' performance with national quality and cost benchmarks.
Most practices too small for solid stats: study
Researchers from the CMS, the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, N.H., and Weill Cornell Medical College's Public Health Department in New York noted that their “purpose was to measure the potential for measuring performance, not performance per se.” They looked at the 2005 Medicare records of 71,980 primary-care physicians and calculated their caseloads for women 66 to 69 years old getting mammography screenings; hemoglobin A1c testing for 66- to 75-year-old diabetics; preventable hospitalizations; and 30-day hospital readmission rate after discharge for congestive heart failure. The researchers found few practices had enough patients to reliably detect a 10% difference in cost or quality measures.
The authors concluded that “rethinking the approach to performance measurement in ambulatory care may be necessary for the Medicare program.” They added that, while
measuring performance over two- to three-year periods could be done, it would lack timeliness.
In an accompanying editorial, Donald Berwick, president and CEO of the Institute for Healthcare Improvement, wrote that this study shows the need to aggregate data from more than one payer and to expand researchers' ability to track and measure patients' health and function. “Measuring a mammography rate or the frequency of assessment of glycated hemoglobin is a far cry from measuring true aims: health, function and comfort,” Berwick stated.
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