You've probably noticed that new JCAHO National Patient Safety Goals are out. Some new goals have been added this year. These goals are some of the most prominent new measures, metrics, and indcators that are being introduced to healthcare. At the Westgard Workshops, Teresa Darcy, MD, MMM, gave a presentation on this recent proliferation of Quality Indicators.
Do you know how many Indicators are out there? Here's just a short list of what Dr. Darcy discussed:
- IQLM Indicators Workgroup: 12 core indicators
- CAP Lab General: 11 key indicators
- JCAHO National Patient Safety Goals: 15 goals so far, with 23 As, Bs, and Cs
- AHRQuality Program: 4 modules, 91 conditions, measures, and indicators
- NCQA Health Plan Employer and Data Set (HEDIS®) specifications: 7 volumes
- NQF Compendium 2000-2005: over 200 consensus standards
- International Quality Indicators Project: 5 care sections, 39 indicators, numerous subparts
- Quality Indicators Project: 5 sections, 42 indicators, numerous subparts
These committees, commissions, taskforces, and groups are also forming at the state level. As part of the Patient Safety movement, states are beginning to collect and publish the measurements of key events. Sometimes these are adverse events, other times they are performance measurements. In Wisconsin, for instance, there is now a Collaborative for Healthcare Quality, with 6 Aims, 9 Clinical Topics, 44 Measures, and 3 "Exclusive" Measures. All of these data points are used to rank the hospitals against their in-state competitors.
Do you see anything wrong with this picture? I didn't realize how many committees are working on quality indicators, so I found Dr. Darcy's presentation eye-opening. As new committees are formed, I guess the old ones keep going. And more indicators and measures are created, more reports are compiled, and we hope that this somehow changes what's being done. Should we create a committee for meauring the impact of these committees?
There's no question these groups are all created with good intentions. Everyone is trying to improve medical care. They are all finding useful ways to determine the quality of care. But the law of diminishing returns kicks in at some point.
At some point, we may create an indicator death spiral: a hospital will spend more time measuring itself than serving the patient. You can see the punchline: "The operation was a success. The hospital is in compliance. Our indicators are good. And the patient died."
The lure of committees is strong. Creating a NEW COMMITTEE looks like you're taking action, when in reality, committees are slow-moving beasts, usually incremental in approach, and rarely have the power to change any uncomfortable realities.
One last point - out of all these indicators, can you guess how many directly discuss laboratory analytical quality?
Always the bridesmaid...
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