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Unreliable 'outcomes' measures hamper efforts to assure better, safer care
Date:4/7/2011

With a push to make hospitals and doctors more accountable for health care quality, more attention must be paid to the accuracy and reliability of measures used to evaluate caregivers, says a prominent Johns Hopkins patient safety expert.

Writing in the April issue of the journal Health Affairs, Peter J. Pronovost, M.D., Ph.D., a professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine, argues that as the desire to evaluate and improve health care intensifies, there remains little consensus as to which measures are scientifically valid and accurate assessments of quality. This risks misinforming patients who may make decisions based on metrics that poorly reflect the state of health care provided by hospitals and may ultimately lead to a failure to make improvements in hospitals where quality is judged to be better than it is, he says.

"There is bipartisan support behind efforts to start paying for value rather than volume," Pronovost says. "This is great, but we act as if there's a whole library of reliable outcome measures for us to use and the fact is that serious work needs to be done to create them. We can't shrink from doing this science. We need to be guided by it."

Acknowledging that substantial shortcomings in the quality of care persist, causing needless patient harm and increasing health care costs, Pronovost says fixes can't be put in place until rigorous scientific data show exactly where systems are broken and until hard comparative evidence points to what types of repairs work best.

In the absence of such safety and efficacy science, he says, there will remain little consensus among hospitals and physicians about the best methods to judge quality or improvement. For example, he notes that overall hospital death rates are an imperfect reflection of quality of care, but in some cases they are the only measures used.

Pronovost, writing with Richard
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Contact: Stephanie Desmon
sdesmon1@jhmi.edu
410-955-8665
Johns Hopkins Medical Institutions
Source:Eurekalert

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