Quality When Nobody is Watching?

Last week’s issue of The New England Journal of Medicine has an article that demonstrates that, in Britain, when incentives for achieving quality targets are removed, doctors’ behavior changes, and they don’t do those things anymore.

But the authors do admit that it may have something to do with the EMRs. It’s one thing to counsel a patient on a myriad of things, yet another to click all the awkwardly placed boxes to actually get credit for it. In my own EMR, there are a half dozen ways to document that BMI counseling was done, but only one shows up in the quality reports. If nobody’s counting, why make all the extra clicks for the bean counters; the office note still says I did it…

What the authors don’t say is that the “quality” parameters they looked at, from 2010 to 2017, include lipid control. I don’t know about the U.K., but in this country, the 2013 lipid guidelines ABANDONED and DISMISSED lipid TARGETS, since some cholesterol treatments have turned out to have little or no effect on cardiovascular mortality.

Quality is really too hard for nonmedical people and even medical administrators to try to measure.


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