Quality Measures Fail Again

I think the most consistent thing about contrived quality measures, as a way to pay doctors or hospitals, is that they are pretty much always a failure:

  • Current ways to risk-adjust heart failure mortality as a measure of hospital-level quality are insufficient, suggested a study showing that accounting for do-not-resuscitate (DNR) orders reshuffles institutional rankings.
  • A DNR order initiated within 24 hours of admission was associated with greater odds of in-hospital death (9.9% versus 2.1% without DNR, adjusted RR 3.63, 95% CI 3.17-4.16). Hospitals with more DNR patients reported higher risk-standardized mortality (P<0.001).
  • “Given public reporting of heart failure mortality measurements and their influence on reimbursement, accounting for the presence of early DNR orders in quality measures should be considered,” the investigators suggested.

A few things here to tease out.  If you or your family members are being pushed to fill out DNR orders then they are pretty much going to die.  Secondly, hospitals want their money and they DO NOT want sick patients to count against their grades.  Therefore, they want a way to remove the sickest ones.

Do you see how this quality crap gets a little bit sticky?  It forces hospitals or doctors to concentrate on the things that only get measured.  It makes hospitals beg to have the measuring stick changed.  It gives both groups the tendency to fudge or cheat.

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