Pitfalls of Converting Practice Guidelines Into Quality Measures

Improving Performance on Preventive Health Quality Measures Using Clinical Decision Support to Capture Care Done Elsewhere and Patient Exceptions

“…Although patient and medical exceptions to preventive health services are perceived to be common in clinical practice, they were uncommon in this study and did not affect performance significantly. Patient refusal rates in this study were lower than those reported in other studies for pneumococcal vaccination 26,27 and colorectal cancer screening 28,29 and may underestimate the true frequency. However, they approximate those reported in a similarly designed CDS reminder study.…”

Primary Care Clinicians' Experiences With Treatment Decision Making for Older Persons With Multiple Conditions

“…The experience of the clinicians who feel pressure to modify their practice based on their exposure to clinical reminders and quality measures supports efforts for modifying these metrics for persons with multiple conditions 28. The concerns expressed by the primary care clinicians in this study that their subspecialist colleagues may not consider the wider harms and benefits of organ-specific intervention reflect the fragmentation of care for patients who receive care from many physicians for their multiple conditions.…”

Medical Center Characteristics Associated with PSA Screening in Elderly Veterans with Limited Life Expectancy

“…These programs have been criticized by some as encouraging a one-size-fits-all approach to care. 37,38 We found that medical centers are uniformly not targeting screening according to life expectancy, regardless of performance measures or whether a center has a high or low overall screening rate. Not only do high screening VAs screen many men with limited life expectancy who should not be screened, but centers screening few men with limited life expectancy also screen few men with favorable life expectancy, for whom some guidelines recommend screening.…”