Looking for Quality under the Lamppost
Concepts such as clinical complexity, multimorbidity, severity of illness, and disease burden seek to characterize the subset of patients whose severity and/or number of illnesses disproportionately affect their lives. We see many such patients in our clinics and in our hospitals. As the numbers of these patients grow, with escalating health care costs and utilization, it is increasingly urgent to answer the following questions: Are these clinically complex patients receiving quality care? Are they satisfied with their experience with the health care system? How can we best measure these important domains and ensure that quality measures adequately are directing providers and health systems to prioritize attention and resources to the most important areas for these patients? These issues, while important for all patients, are especially critical for clinically complex patients.
The paper by Werner and Chang both adds to our understanding of these issues as well as highlights some of the ...
- Werner RM, Chang VW. The relationship between measured performance and satisfaction with care among clinical complex patients. JGIM. doi:10.1007/s11606-008-0734-6.
- Higashi T, Wenger NS, Adams JL, et al. Relationship between number of medical conditions and quality of care. NEJM. 2007;356(24)2496–504. CrossRef
- Min LC, Wenger NS, Fung C, et al. Multimorbidity is associated with better quality of care among vulnerable elders. Med Care. 2007;45(6)480–8. CrossRef
- Rosen AK, Loveland S, Anderson JJ. Applying diagnostic cost groups to examine the disease burden of VA facilities: Comparing the six “Evaluating VA costs” study sites with other VA sites and Medicare. Med Care. 2003;41;6(Suppl II)91–102.
- Ren XS, Kazis L, Lee A, Rogers W, Pendergrass S. Health status and satisfaction with health care: a longitudinal study among patients served by the veterans health administration. Am J Med Qual. 2001;16(5)166–73. CrossRef
- Plomondon ME, Runsfeld JS, Humble CG, et al. Factors influencing risk-adjusted patient satisfaction after coronary artery bypass grafting. Am J Cardiol. 2003;92:206–8. CrossRef
- Kerr EA, Smith DM, Kaplan SH, Hayward RA. The association between three different measures of health status and satisfaction among patients with diabetes. Med Care Res Rev. 2003;60(2)158–77. CrossRef
- Tinetti ME, Bogardus ST, Agostini JV. Potential pitfalls of disease-specific guidelines for patients with multiple conditions. NEJM. 2004;351(27)2870–4. CrossRef
- Boyd CM, Darer J, Boult C, Fried LP, Boult L, Wu AW. Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases; implications for pay for performance. JAMA. 2005;294(6)716–24. CrossRef
- Hayward RA. All-or-nothing treatment targets make bad performance measures. American Journal of Managed Care. 2007;13(3)126–8.
- Kent DM, Hayward RA. Limitations of applying summary results of clinical trials to individual patients: the need for risk stratification. JAMA. 2007;298(10)1209–12. CrossRef
- Hayward RA, Kent DM, Vijan S, Hofer TP. Reporting clinical trial results to inform providers, payers and consumers. Health Aff. 2005;24(6)1571–81. CrossRef
- McMahon LF Jr, Hayward RA, Saint S, Chernew ME, Fendrick AM. Univariate solutions in a multivariate world; can we afford to practice as in the “good old days”? American Journal of Managed Care. 2005;11(8)473–6.
- Schmittdiel J, Vijan S, Fireman B, Lafata JE, Oestreicher N, Selby JV. Predicted quality-adjusted life years as a composite measure of the clinical value of diabetes risk factor control. Med Care. 2007;45(4)315–21. CrossRef
- Looking for Quality under the Lamppost
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- Available under Open Access This content is freely available online to anyone, anywhere at any time.
Journal of General Internal Medicine
Volume 23, Issue 11 , pp 1923-1925
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- 1. Division of General Medicine, School of Medicine, University of Michigan, Ann Arbor, MI, USA
- 2. Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
- 4. Ann Arbor, MI, USA
- 3. Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Veterans Health System, Ann Arbor, MI, USA