In my last post about using the healthcare system, I talked about patient satisfaction surveys as a way to measure its quality.  But measuring satisfaction is only part of health care quality.  You may be satisfied with the care your physician provides, but is it medically appropriate and up-to-date?

Another kind of measure looks at how well all the doctor’s patients with certain common characteristics stack up against some specialty recommendations.  This approach works well for preventive measures for patients of a certain gender and age, such as, immunizations for children or mammography rates for women.  It’s also used to measure care delivered to patients with certain chronic conditions, such as diabetes or heart failure.  These measures cover whether certain tests have been performed on a regular basis and whether certain medications proven to be effective in managing the condition are being taken by the patient.  They also may include what percentage of the patients with the condition are under control by attaining certain standards, such as blood pressure or the A1C level for the diabetic.

There are certain problems with these measures.  First, sometimes more than one medical organization releases conflicting recommendations for the same test or procedure.  For example, the United States Preventive Services Task Force (USPSTF) recommends screening mammograms for women every other year after the age of 50, whereas the American Cancer Society (ACS)  recommends that it be done every year after the age of 40.  Which should be used?  Another problem with some of these measures is that they don’t always accurately reflect the physician’s practice.  With most of them, the physician may order a test or a medication, but the patient must follow through and have the test done or fill the prescription and take the medication.  Another weakness of these measures is that while they can work for primary care and some specialties, they can’t be applied to all specialists.  With time more specialty-specific measures may be developed.  Finally, gathering the data to do the calculations can be a problem, though as more and more practices adopt an electronic medical record, that problem may be reduced.  More about that in the next post, when I discuss clinical pathways.

Some health plans publish some of these kinds of measures for their physician network.  Have you ever seen them or used them?  Please share your experiences with healthcare quality by leaving a comment.

For Your Health – Dr. Bob