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JAMA Study: Performance Measures Neglect Health Care Overuse

Authors recommend ‘Goldilocks approach’ to care

Clinical performance measures –– quality indicators used to evaluate and motivate health care providers' performance –– have taken center stage in efforts to improve quality in health care on a national level, according to an article on News-Medical.net.

Lead author Erika Newton, MD, MPH, of Stony Brook Medicine and her colleagues examined 16 national collections of performance measures in widespread use, defined as those in major national measure programs or clearinghouses, such as the National Quality Forum. They found that more than 90% of 521 outpatient measures targeted underuse of care and that only 7% addressed overuse of care. Their study was published online in JAMA Internal Medicine.

 “Our findings suggest that, by focusing almost single-mindedly on identifying and penalizing underuse, current outpatient performance measures may well foster a culture of ‘more is better’ ─ and inadvertently encourage overuse of care,” Newton said.

On a positive note, the authors concluded that although the current system of clinical performance measurement may be significantly slanted toward measuring whether patients are receiving “enough” care, performance measurement is nonetheless “well positioned to address both underuse and overuse,” particularly if policymakers actively monitor the aggregate effects.

They added that the development and implementation of measure collections ─ or individual measures themselves ─ that address both underuse and overuse of care could represent a “Goldilocks approach to performance measurement [that] could encourage clinicians and institutions to target a balance of care that is just right.”Clinical performance measures - quality indicators used to evaluate and motivate health care providers' performance - have taken center stage in efforts to improve quality in health care on a national level. Lead author Erika Newton, MD,MPH, Clinical Assistant Professor of Emergency Medicine at Stony Brook Medicine, and Brenda Sirovich, MD,MS, of the Outcomes Group, VA Medical Center, White River Junction, VT, and the Dartmouth Institute, and colleagues examined 16 national collections of performance measures and found that more than 90 percent of 521 outpatient measures targeted underuse of care and only 7 percent addressed overuse of care. Their findings are reported in the online first edition of JAMA-Internal Medicine.

Previous research on care overuse has analyzed demographics and causes. For example, research earlier this year found that while race and ethnicity do not correlate with overuse of care, heavy concentrations of overuse exist among white patients, FierceHealthcare previously reported. Reinforcing the concerns expressed in the new JAMA paper, however, the researchers noted that the low quality and relative rarity of existing research on the topic made it difficult to draw conclusions.

Meanwhile, a February study indicated that overuse occurs in response to patient requests only 1% of the time, suggesting poor communication between patients and providers may be the driving factor, according to FiercePracticeManagement.

Sources: FierceHealthcare; August 12, 2015; News-Medical.net; August 11, 2015; and JAMA Internal Medicine; August 10, 2015.

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