Evaluating quality of care: how does the VA measure up?

PharmacoEconomics & Outcomes News 454 - 5 Jun 2004

Evaluating quality of care: howdoes the VA measure up?

Assessing quality of care via clinical measuresconverted from practice guidelines is a "youngtechnology that requires further evaluation before it canachieve its full role in improving patient care", say US-based researchers.

They critically evaluated the colorectal cancerscreening performance measure used by the USDepartment of Veterans Affairs (VA) to assess quality ofcare at each of its medical centres. Analysis of medicalrecords for patients audited for colorectal screening in2002 revealed "several pitfalls" associated withconverting practice guidelines into performancemeasures, note the researchers. Indeed, the illnessseverity of the sample population audited for colorectalcancer screening adherence was not considered by theVA, consequently screening was targeted "to patientswho were much sicker than the healthy volunteers whoparticipated in randomized trials of screening", theycontend.

In addition, high target screening rates appeared to beset without considering the fact that many patients (42%of those audited) were tested for "diagnostic rather thanscreening purposes", the researchers say. A third pitfallthe researchers identified was that patient preferencesor clinician judgement were not taken into account inthe development of the measure. The quality ofscreening could be better measured throughconsidering "thoughtful decision making that includesprognosis and patient preferences", the researcherssuggest. These potential issues seem especiallyimportant given the recent Institute of Medicinerecommendation to apply many VA performancemeasurement and reporting practices to "the US healthcare system as a whole", contend the researchers.Walter LC, et al. Pitfalls of converting practice guidelines into quality measures:lessons learned from a VA performance measure. JAMA: the Journal of theAmerican Medical Association 291: 2466-2470, No. 20, 26 May 2004 800973503

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PharmacoEconomics & Outcomes News 5 Jun 2004 No. 4541173-5503/10/0454-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved