The New England Journal of Medicine has a fun little post examining measures for performance improvement. As you may or may not know, doctors are notoriously bad at following guidelines or understanding evidence. Many patients wander through the healthcare system getting too much of the wrong care and sometimes not enough of what they need. (Hence the RightCare Alliance, which tries to find the “just right” sort of balance.) The understandable inclination of hospitals, insurance companies, the government, and anyone else who pays for care is to press for performance improvement or quality improvement, mostly by measuring certain standards (e.g. whether or not patients are getting to a specific blood pressure) and then using data (often acquired through the EMRs that are like texting while driving) to determine whether or not certain targets are being met. Sounds like a great idea!

Except that a bunch of measures that have been proposed (or are being used!) are garbage:

The fact that only 37% of measures proposed for a national value-based purchasing program were found to be valid with a standardized method has implications for physician-level performance measurement. The use of flawed measures is not only frustrating to physicians but also potentially harmful to patients. Moreover, such activities introduce inefficiencies and administrative costs into a health system widely regarded as too expensive.

It’s not an easy dilemma: we want to hold doctors to some kind of standard for care, but the number of standards we can apply across the board is a lot lower than we’d like it to be. I personally think that a system where the most basic things are done by community health workers in tandem with computers might free up doctors to not be burdened with such things, but the problem of choosing which standards to apply is still going to be thorny.

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Posted by Matthew Loftus

Matthew Loftus teaches and practices Family Medicine in Baltimore and East Africa. His work has been featured in Christianity Today, Comment, & First Things and he is a regular contributor for Christ and Pop Culture. You can learn more about his work and writing at