Interesting stories about the effects of current quality of care efforts. In both cases, the quality assurance measure (implemented by an administrator, i.e. "the suit") did not make clinical sense to the doctor and was felt to have a negative impact on their professional autonomy. This could be seen as evidence supporting the complex adaptive system theory of health services and illustrating how a pure mechanistic approach to such as system can be problematic and even counter-productive.
jd
HEDIS measures — db's Medical Rants
HEDIS like most other quality improvement measures, comes from administrative data and its inherent inability to perform the task at varied extent. In spite of the negatives like focusing on limited number of measures, no universal agreement on what should be measured, validity of measure, risk adjustments and so forth, it is one of the most comprehensive and widely used quality measure. There have been introduction of various versions of HEDIS since its inception which is to a certain extent result of "complex adaptive system". However one of the major drawback is that the adaptation is at macro level of system rather than at micro level. One of the commenter mentioned about introducing such measures tools at "micro-environment of practice settings" where a group of providers come to consensus on what to measure and how to measure, retaining their autonomy to greater extent. Outcomes rather than process of care should be focused.
ReplyDeleteMoreover, some of the classic models of quality improvement occur in confidential environment and dissemination of performance on such measures in public hampers the philosophy and has negative impact on providers.
This discussion seems relevant to our work in trying to design a health system. How much freedom should be built into the system so that physicians can make equitable decisions for their patients? It might seem that a system with national rules and regulations could hinder physician autonomy to the point of making their practices in particular cases dangerous or useless (as the two stories above relate). But how do you also ensure a baseline of health procedures? Perhaps health care needs of distinct regions should be evaluated and funding/rating schemes based on the needs of the local population. On the other hand, the system could lay out basic regulations and quality measures for the most necessary procedures, and leave a certain amount of funding open for local authorities to distribute. This issue also touches on the modeling we have discussed in class. The system is complex and the model used to evaluate it is obviously simplifying to the point of being ineffective in these particular cases. Perhaps further study of this area will help us understand the trade-offs that are necessary in such modeling and how to account for them when these types of concerns arise.
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