Playing the quality game

As I recently blogged, the quality and P4P movement is not mature enough for prime time and may be of little more than cosmetic importance. In addition to numerous unintended consequences, some publicly reported “quality” measures (e.g. pneumococcal vaccination) may not even be effective.

Two articles just out in Chest now raise questions about time to first antibiotic dose (TFAD) for pneumonia as a quality indicator. One of these, cited by Kevin and DB, suggests that the incentive could lead to hasty (and inappropriate) antibiotic use. The other paper analyzed records of patients who received antibiotics outside the 4 hour window, thus “failing” the quality screen. The findings suggest that age and comorbidities contributing to an atypical presentation of pneumonia were responsible for the delays. Moreover, these same patient attributes, rather than the delay itself, are causally related to the adverse outcomes associated with delayed administration.