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To Your Health: NLM update Transcript

Measuring the quality of care?: 07/09/2018

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Greetings from the National Library of Medicine and MedlinePlus.gov

Regards to all our listeners!

I'm Rob Logan, Ph.D., senior staff, U.S. National Library of Medicine (NLM).

Here is what's new this week in To Your Health, a consumer health-oriented podcast from NLM, that helps you use MedlinePlus to follow up on weekly topics.

An array of hospital and physician performance measures fail to measure the quality of care and need to be replaced with more focused assessment tools, suggests a committee of the American College of Physicians in a perspective recently published in the New England Journal of Medicine.

The perspective's three authors (representing the clinical performance measurement committee of the American College of Physicians -ACP) report 63 percent of physicians believe the current performance measures in hospitals and clinics (and we quote): 'do not capture the quality of care that physicians provide' (end of quote).

The perspective's authors add physician practices spend about $15.4 billion annually, or about $40,000 per M.D. — to report their clinical performance via the tools the ACP committee assessed. Hence, the report suggests current expenditures do not produce useful feedback to the nation's internists.

Specifically, the ACP committee identified and rated the validity of 86 measures that are most relevant to general internal medical ambulatory patients and care. The authors report the ACP committee found only 37 percent of these frequently used measures are valid, or measure what they purport to assess within clinical settings.

Moreover, among the routine clinical measures that were deemed invalid, the authors note 19 provided insufficient evidence to support their continued use.

For example, the authors cite a measure to control blood pressure that provides a standard to be achieved in clinical settings for all patients. However upon evaluation, the ACP study counters (and we quote): 'Forcing blood pressure down to this threshold could harm frail elderly adults and patients with certain coexisting conditions' (end of quote).

The authors suggest current easy-to-obtain administrative data and measures that are intended to stand alone as a retrospective exercise should evolve into assessments that can be integrated into the routine delivery of patient care. The authors write future assessment should (and we quote): 'effectively address the most pressing performance gaps and direct quality improvements' (end of quote) in medical centers.

Interestingly, the perspective concludes with the authors' suggestion for a 'time out' to reassess and revise widely used, expensive clinical performance measures. Overall, the perspective suggests that the way physician and hospital performances are measured need significant improvement in order to provide useful evidence about the status quo of patient care.

Meanwhile, questions for patients to ask in order to obtain quality ambulatory care (from the Joint Commission) are available within the 'start here' section of MedlinePlus.gov's health facilities health topic page.

A guide to help compare doctors, hospitals, and care plans from the U.S. Centers for Medicare & Medicaid Services is available in the 'find an expert' section of MedlinePlus.gov's health facilities health topic page.

Links to the latest pertinent journal research articles about health facilities are available in the 'journal articles' section of MedlinePlus.gov's health facilities health topic page.

To find MedlinePlus.gov's health facilities health topic page, please type 'health facilities' in the search box on MedlinePlus.gov's home page, then, click on 'health facilities (National Library of Medicine).' MedlinePlus.gov also contains a health topic page on patient safety.

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It was nice to be with you. Please join us here next week and here's to your health!