By Sten Westgard, MS
“Our
results also question the validity of using HbA1c test results as a measure of
the quality of diabetes care. Given the
present state of the art for HbA1c testing, the proposed pay-for-performance
use of these results could lead to an ironic scenario in which analytic methods
that are biased low relative to the NGSP reference method are considered to
reflect a high quality of care and secure a better level of reimbursement for
the provider while at the same time promoting clinical inertia for the
intensification of diabetes treatment and underestimating the risk of diabetic
complications.”
“The gap between the level of analytic quality that experts consider necessary to obtain the maximum clinical usefulness from an HbA1c test and the level of performance presently provided by the methods used in the United States suggests that there is, indeed, cause for concern. The shortcomings of contemporary HbA1c testing need to be more widely recognized by the end users of the results. In addition, individuals and organizations involved in the design, manufacturer, performance, accreditation, and regulation of HbA1c testing need to devise and implement plans for improving the analytic quality of this important test.”
Holmes EW, Ersahin C, Augustine GJ, Charnogursky GA, Gryzbac M, Muttell JV, McKenna
KM, Habhan F, Kahn SE. Analytic bias amoung certified methods for the
measurement of hemoglobin A1c. Am J Clin Pathol 2008;129;540-547.
When you add pay for performance on top of the method bias problems, you've got a scary scenario. Just by switching to a new, lower-reporting method, clinicians and institutions could increase their compensation - without ever changing the quality of healthcare delivered to patients. That's not pay for performance. That's pay for method bias.
Hi,
Regarding the said worries on the essay:http://www.westgard.com/essay123.htm
My understanding is that the average BG or eAG (not necessarily fasting during the day) is not referring to average fasting glucose (FPG).
Kind regards,
Richard Pang
Posted by: Richard Pang | December 18, 2008 at 08:28 AM