When it comes to quality measurement, "we're hitting the targets, but missing the point," Robert Wachter, interim chair of the University of California-San Francisco's department of medicine, writes in a New York Times opinion piece.
The health care system has come a long way since the 20th century, Wachter notes, when there was a more passive approach to assessing quality, based on the idea that many health outcomes were too complex to be measured.
That changed by the early 2000s amid increasing evidence of poor outcomes, including hundreds of thousands of deaths from medical errors, and as costs continued to rise, Wachter writes. The push to measure and improve quality has led to lifesaving improvements in some areas, such as a reduction in hospital-acquired infections.
But Wachter contends that "the measurement fad has spun out of control," with physicians responsible for tracking so many outcomes and process measures that patient interaction has suffered and burn-out rates are on the rise .
Many physicians feel that the focus on measurement—and what Wachter calls the "incentives to 'look good'"—have forced them to "to turn away from the essence of their work."
Wachter does not call for an end to quality measurement but instead advocates for "more targeted measures, ones that have been vetted to ensure that they really matter." He calls for more research into the different factors that influence outcomes in order to better adjust for risk.
And he believes it's most crucial to find ways to reduce the burden on physicians, asserting that they spend too much time checking boxes to verify that they've completed certain tasks. He suggests that natural language processing that translates physician notes into completed tasks in the system could provide relief.
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Regardless, he says, we need to ask clinicians "whether measurement is working, and truly listen when they tell us that it isn't. Today, that is precisely what they're saying" (Wachter, New York Times, 1/16).
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