The Unintended Consequences of Quality Metrics (FR418)

Recruiting Research Participants via Traditional Snowball vs Facebook Advertisements and a Website

“…Intended to improve quality and decrease cost of care, there is evidence that in at least some cases, measurement leads to unexpected and even harmful outcomes, termed metric-driven harm. For example, data suggests that in some cases, health care providers have delayed necessary hospital readmissions within 30 days of discharge from the hospital (Fonarow, 2018), denied patients surgical procedures due to the risk of mortality (Toevs et al, 2017; Wadhera et al, 2017), and prolonged the life of a critically ill, post-surgical patient until the patient was past the measurement period of 30 days post-operative (Rambur et al, 2013) Although discussion of the value and challenges of performance measures is widespread, including articles in the lay literature that argue its centrality to meaningful health reform (Marcotte et al, 2017), there is scant discussion of nurses’ experiences of measurement. Thus, the purpose of the original study was to explore and better understand nurses’ reported perceptions of performance measures and measurement-driven behavior, including harm.…”