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New Recommendations for Quality Performance Measures

Bands of performance better than all-or-nothing expectations

TUESDAY, July 1 (HealthDay News) -- Health care quality performance measures should be developed with the participation of end users and should take a cautious and flexible approach, according to an article published in the July 1 issue of the Annals of Internal Medicine.

Robert M. Wachter, M.D., of the University of California San Francisco, and colleagues analyzed the implementation of the four-hour rule for the administration of antibiotics in cases of community-acquired pneumonia to assess the impact on patient care. The rule serves as an example of a flawed performance measure because it puts pressure on clinicians to treat before they could make a certain diagnosis, and has recently been revised to six hours.

The authors made five recommendations about future quality measures: extrapolation of known diagnoses to those without a diagnosis should be done with caution; "bands" of performance are more useful than a black-and-white approach; the end users of the measures should be involved in their development; a mechanism for reassessment should be built into the measures; and possible financial and intellectual biases must be recognized.

"As we enter this new world of quality measurement, public reporting and pay-for-performance, missteps will happen," the authors write. "This should not dissuade us from promoting interventions that can improve patient care nor lead us to insist on unattainable levels of evidence before proceeding."

The authors report a financial relationship with several organizations, including The American Board of Internal Medicine, Healthcare Advisory Board, and the Agency for Healthcare Research and Quality.

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