Evaluating the Quality of Health Care

8. Comprehensiveness of Measures

Unfortunately, developing and using a comprehensive assessment, such as the one used by McGlynn et al. (McGlynn, et al., 2003) is very complicated and expensive. As providers of health care in the Unites States increasingly adopt electronic medical records and continue standardizing the way information is entered and shared, there undoubtedly will be increasing opportunities to develop more comprehensive process measures of care based on information from those systems.(Bates, Ebell, Gotlieb, Zapp, & Mullins, 2003; Poon, et al., 2010; Simon, S. R., R. Kaushal, P.D. Cleary, C.A. Jenter, L.A. Volk, E.J. Orav, E. Burdick, E.G. Poon, D.W. Bates, 2006; Simon, S. R., et al., 2009)

Available studies indicate that it is difficult to generalize from the quality of care for one set of symptoms or diseases to the quality of care for another set of symptoms or diseases.  For example, a study of six medical and surgical interventions at six teaching hospitals showed that the rank ordering of the hospitals' performance in terms of both process and outcome measures differed depending on the intervention.(Cleary, P. D., Greenfield, et al., 1991). Even for a specific condition, the fact that one aspect or care is performed well may not predict the quality of a different aspect of care for the same condition (Wilson, .IB., et al., 2007).  Innovative organizations, such Intermountain Healthcare and the Boston based Institute for Healthcare Improvement are focusing on improving the systems that should support better care across a wide range of processes, but to date, it does not appear that such comprehensive approaches to quality improvement are widespread enough to allow one to generalize about quality on the basis of a few conditions, diagnoses, or symptoms. Such generalizations are especially problematic when different types of medical functions are evaluated, such as screening, prevention, diagnosis, and treatment. Thus, a sound measure of the quality of care must include separate measures for the care provided by different clinicians or organizations or even different functions or procedures provided by the same clinician. 

Simon, S. R., R. Kaushal, P.D. Cleary, C.A. Jenter, L.A. Volk, E.J. Orav, E. Burdick, E.G. Poon, D.W. Bates. (2006). How and Why Are Physicians Using Electronic Health Records? A Statewide Survey. Arch Int Med.