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Harlan M. Krumholz

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Point-Counterpoint: Hospital Scorecards and Quality. The Quality Colloquium at Harvard ... What is acceptable imperfection' may depend on the use of measurement ... – PowerPoint PPT presentation

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Title: Harlan M. Krumholz


1
Point-Counterpoint Hospital Scorecards and
Quality The Quality Colloquium at Harvard August
22, 2005
Harlan M. Krumholz Professor of Medicine Yale
University School of Medicine
2
Major Points
  • Measurement can be important
  • Quality improvement
  • Consumer choice
  • Accountability/financial incentives
  • What is acceptable imperfection may depend on
    the use of measurement
  • At this stage of development, there are many
    potential concerns

3
Concern 1 Hype Exceeds Reality
  • Even the famous are seduced

Who is left to critique when the top academic
hospitals are co-opted?
4
Concern 2 Accuracy
  • Many measures lack accuracy

For example AHRQ Failure to Rescue measure fails
to identify the right patients gt 50
5
Concern 3 Discrimination
  • Groups not homogeneous in performance

Red Sox lead the league in batting average and
Pirates trail all teams Not all Red Sox batters
are better than all Pirate batters
6
Problem 4 Proprietary Methods
  • Hard to trust what you cannot see

Many organizations use proprietary methods to
profile hospitals.
7
Problem 5 Validation
  • Lack of validation of secondary sources

Many measures are based on secondary data sources
that have not been validated
8
Problem 6 Statistical Approach
  • Many systems do not employ appropriate methods

For example Hard to tell if differences are due
to chance.
9
Problem 7 Reporting
  • Too simplistic or too complex

Do consumers really understand the nuances?
10
Questions
  • How good is good enough?
  • What are appropriate measures?
  • Structure
  • Process
  • Outcome
  • How can we help provide patients the information
    they need?

11
Thoughts
  • As measurement has consequence, we must
    acknowledge the potential for both beneficial and
    adverse consequences
  • Who will grade the graders?
  • The need for standards
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