Abstract
Over the past decade, quality measures (QMs) have been implemented nationally in order to establish standards aimed at improving the quality of care. With the expansion of their role in the Affordable Care Act and pay-for-performance, QMs have had an increasingly significant impact on clinical practice. However, adverse patient outcomes have resulted from adherence to some previously promulgated performance measures. Several of these QMs with unintended consequences, including the initiation of perioperative beta-blockers in noncardiac surgery and intensive insulin therapy for critically ill patients, were instituted as QMs years before large randomized trials ultimately refuted their use. The future of quality care should emphasize the importance of evidence-based, peer-reviewed measures.
Highlights
Over the past decade, quality measures (QMs) have assumed a crucial role in the healthcare landscape
We explore the use of patient safety indicators and reduced 30-day readmission rates, which have an increasing role in the assessment of hospital quality and compensation
The committee concluded that there were multiple instances of scientific misconduct represented in the collection, analysis, and representation of source data. Subsequent to this announcement, a meta-analysis published in 2013 with consolidated outcomes of over 10,000 randomized participants showed that initiation of perioperative beta-blockers (PBB) before surgery caused a significant increase in mortality, whereas the DECREASE data had shown a non-significant reduction in mortality.[29]. It was only after additional randomized controlled trial (RCT) had countered the results of DECREASE that, in 2014, the European Society of Cardiology (ESC) guidelines recommended against the initiation of PBB for patients undergoing low- to intermediate-risk noncardiac surgery.[30]
Summary
Quality measures (QMs) have assumed a crucial role in the healthcare landscape. The Affordable Care Act (ACA) mandates that the Centers for Medicare and Medicaid Services (CMS) increase the scope of pay-for-performance nationally As part of this new legislation, value-based purchasing expands the role of pay-forperformance in quality improvement. Hospitals will be offered incentive payments derived from a list of 25 different QMs.[1] Yet despite advances in healthcare quality improvement practices, not all QMs have proven to be of value This is the case when new data emerge that countervail the evidence on which the QM was originally based. Given the potential for adverse consequences, the conversion of guidelines into performance measures should not occur without adequate high-quality evidence In this discussion, we Received September 26, 2014 Accepted March 2, 2015 Published online March 24, 2015 examine two QMs that have had widespread effects on patient care, and that may have led to increased mortality: perioperative beta-blockers and glucose control in critically ill patients. Venous thromboembolism[15] Hospital-acquired pressure ulcers[16] Patient safety indicators[17,18,19,20,21]
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