Thursday, December 04, 2008

Performance does not equal quality

DB in a recent rant explains why performance measures don’t translate into quality. He says the boosters have pulled a fast one on us by confusing performance with real quality. I have to agree. Let’s call the performance measures what they are---performance measures, not quality measures.

One of his commenters gently takes him to task:

The best we can do is to continually test the relationships between “quality measures” at all levels and the final results we desire. Waiting for perfect measures is unrealistic.

I have to ask: if you don’t think guidelines should be followed in the populations for whom they are designed (which is how we identify the denominator populations for Bernoulli-distributed process measures), with whom are you really arguing?

I suppose the alternative is to reject empiricism entirely and adopt the framework of Cartesian doubt.

I don’t read DB as knocking EBM, or even guidelines, although he has been critical of the way they are promoted. My take is that today’s performance measures have little to do with true EBM. Moreover the performance police, in an effort to get everyone on board with a minimum standard of guideline based care, have misappropriated and over simplified those same guidelines.

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