Quality vs. Volume

I am not a big believer in quality metrics, as you may know, but I found this study interesting. Doctors were graded on these metrics for diabetics over a two year period:

  • Disease monitoring (eye examination, hemoglobin A1c testing, and low-density lipoprotein cholesterol testing)
  • Prescription of appropriate medications (angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers and statins)
  • Adverse clinical outcomes (emergency department visits for hypoglycemia or hyperglycemia).

It turns out that there was a correlation between higher overall ambulatory volume and lower rates of appropriate diabetes monitoring and medication prescription.

“Primary care physicians with busier ambulatory patient practices delivered lower-quality diabetes care, but those with greater diabetes-specific experience delivered higher-quality care,” the authors write.

So, if you have a jam-packed schedule in an industrialized mode,l then the odds are you are doing crappier work.  It’s also a reason why doctors with much less volume do better on these scores (DPC docs) or even why midlevels do as well in their home-cooked studies.

How about when you have a supposed “quality based practice” with less patients but half the visit is taken up with the MA (as well as the doctor)  asking meaningless quality metric questions?  I venture to guess they do a crappier job, too.   That’s a study we will never see but I guarantee it would show that the time wasted asking bogus metric questions lowers the quality of that visit.


93890cookie-checkQuality vs. Volume