PharmacoEconomics & Outcomes News 454 - 5 Jun 2004 Evaluating quality of care: how does the VA measure up? Assessing quality of care via clinical measures converted from practice guidelines is a "young technology that requires further evaluation before it can achieve its full role in improving patient care", say US- based researchers. They critically evaluated the colorectal cancer screening performance measure used by the US Department of Veterans Affairs (VA) to assess quality of care at each of its medical centres. Analysis of medical records for patients audited for colorectal screening in 2002 revealed "several pitfalls" associated with converting practice guidelines into performance measures, note the researchers. Indeed, the illness severity of the sample population audited for colorectal cancer screening adherence was not considered by the VA, consequently screening was targeted "to patients who were much sicker than the healthy volunteers who participated in randomized trials of screening", they contend. In addition, high target screening rates appeared to be set without considering the fact that many patients (42% of those audited) were tested for "diagnostic rather than screening purposes", the researchers say. A third pitfall the researchers identified was that patient preferences or clinician judgement were not taken into account in the development of the measure. The quality of screening could be better measured through considering "thoughtful decision making that includes prognosis and patient preferences", the researchers suggest. These potential issues seem especially important given the recent Institute of Medicine recommendation to apply many VA performance measurement and reporting practices to "the US health care 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 the American Medical Association 291: 2466-2470, No. 20, 26 May 2004 800973503 1 PharmacoEconomics & Outcomes News 5 Jun 2004 No. 454 1173-5503/10/0454-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved

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

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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