The Double Edged Sword of Performance Measurement
Among the high priority outcomes sought in reforming American health care are greater provider accountability, better processes of care and improved clinical outcomes, more satisfying care experiences for both patients and caregivers, and greater operational efficiency. Performance measurement is an essential tool for implementing strategies aimed at achieving these goals.
In this issue of the Journal, Powell and colleagues describe a number of unintended consequences of implementing performance measurement in the Department of Veterans Affairs (VA) Health Care System,1 an early adopter of system-wide performance management.2–5 While there are significant limitations in generalizing the findings of this retrospective qualitative study, it is an important contribution to the growing body of evidence documenting the complexities of health care performance measurement and a poignant reminder that performance measurement is a tool that cuts both ways.
Powell et al, report the findings of 59 ...
- Powell AA, White KM, Partin MR, Halek K, Christianson JB, Neil B, et al. Making the grade – Unintended consequences of implementing a national performance measurement system into local practice. JGIM 2012; doi:10.1007/s11606-011-1906-3
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- Trevelyan EW. The Performance Management System of the Veterans Health Administration. Harvard School of Public Health Case Study. Cambridge, MA: Harvard School of Public Health. 2002.
- Thibodeau, N, Evans, JH, Nagarajan, NJ, Whittle, J (2007) Value creation in public enterprises: An empirical analysis of coordinated organizational changes in the Veterans Health Administration. Acc Rev 82: pp. 483-520 CrossRef
- Goddard, M, Davies, HTO, Dawson, D, Mannion, R, McInnes, F (2002) Clinical performance measurement: part 1 – getting the best out of it. J R Soc Med 95: pp. 508-510 CrossRef
- Goddard, M, Davies, HTO, Dawson, D, Mannion, R, McInnes, F (2002) Clinical performance measurement: part 2 – avoiding the pitfalls. J R Soc Med 95: pp. 549-551 CrossRef
- Adair, CE, Simpson, E, Casebeer, AL, Birdsell, J, Hayden, KA, Lewis, S (2006) Performance measurement in healthcare: part II – State of the science findings by stage of the performance measurement process. Healthcare Pol 2: pp. 56-78
- Bevan G, Hood C. What’s measured is what matters: Targets and gaming in the English public health care system. Public Service Progamme Discussion Paper Series: No. 0501. December 2005.
- Freeman, T (2002) Using performance indicators to improve health care quality in the public sector: a review of the literature. Health Serv Manag 15: pp. 126-137 CrossRef
- Werner, RM, Asch, DA (2007) Clinical concerns about clinical performance measurement. Ann Fam Med 5: pp. 159-163 CrossRef
- Kerr, EA, Krein, SL, Vijan, S, Hofer, TP, Hayward, RA (2001) Avoiding pitfalls in chronic disease quality measurement: A case for the next generation of technical quality measures. Am J Managed Care 7: pp. 1033-1043
- Heidenreich, PA, Sahay, A, Kapoor, JR, Pham, MX, Massie, B (2010) Divergent trends in survival and readmission following a hospitalization for heart failure in the Veterans Affairs Health Care System 2002 to 2006. J Am Coll Cardiol 56: pp. 362-368 CrossRef
- Pronovost, PJ, Lilford, R (2011) A road map for improving the performance of performance measures. Health Affairs 30: pp. 569-573 CrossRef
- Walter, LC, Davidowitz, NP, Heineken, PA, Covinsky, KE (2004) Pitfalls of Converting Practice Guidelines Into Quality Measures: Lessons Learned From a VA Performance Measure. JAMA 291: pp. 2466-2470 CrossRef
- Lester, HE, Hannon, KL, Campbell, SM (2011) Identifying unintended consequences of quality indicators: a qualitative study. BMJ Qual Saf 20: pp. 1057-1061 CrossRef
- Jha, A, Perlin, JB, Kizer, KW, Dudley, RA (2003) Effect of the transformation of the Veterans Affairs Health Care System on the quality of care. N Engl J Med 348: pp. 2218-2227 CrossRef
- Trivedi, A, Matula, S, Miake-Lye, I, Glassman, PA, Shekelle, P, Asch, S (2011) Systematic review: comparison of the quality of medical care in Veterans Affairs and Non-Veterans Affairs settings. Med Care 49: pp. 76-88 CrossRef
- Trivedi, AN, Grebla, RC (2011) Quality and equity of care in the Veterans Affairs Health-Care System and in Medicare Advantage health plans. Med Care 49: pp. 560-568 CrossRef
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- Asch, SM, McGlynn, EA, Hogan, MM, Hayward, RA, Shekelle, P, Rubenstein, L (2004) Comparison of quality of care for patients in the Veterans Health Administration and patients in a national sample. Ann Intern Med 141: pp. 938-945
- Keating, NL, Landrum, MB, Lamont, EB, Bozeman, SR, Krasnow, SH, Shulman, LN (2011) Quality of care for older persons with cancer in the Veterans Health Administration versus the private sector. A cohort study. Ann Intern Med 154: pp. 727-736
- Baker GR, MacIntosh-Murray A, Porcellato C, Dionne L, Stelmacovich K, Born K. Veterans Affairs New England Healthcare System (Veterans Integrated Service Network 1). New England, US. In, High Performing Healthcare Systems – Delivering Quality by Design. Toronto, Ontario, Canada. Longwoods Publishing Company. 2008.
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- Sawin, C, Walder, D, Bross, D, Pogach, L (2004) Diabetes process and outcome measures in the Department of Veterans Affairs. Diabetes Care 27: pp. b90-b94 CrossRef
- Fleming, BB, Greenfield, S, Engelgau, MM, Pogach, LM, Clauser, SB, Parrot, MA (2001) for the Diabetes Quality Improvement Project Group. The Diabetes Quality Improvement Project. Diabetes Care 24: pp. 1815-1820 CrossRef
- Pogach, LM, Rajan, M, Aron, DC (2006) Comparison of weighted performance measurement and dichotomous thresholds for glycemic control in the Veterans Health Administration. Diabetes Care 29: pp. 241-246 CrossRef
- Jha A. Recommendations from the Under Secretary for Health's International Roundtable on Clinical Quality and Patient Safety. Washington, DC. Veterans Health Administration. April 2009.
- The Double Edged Sword of Performance Measurement
Journal of General Internal Medicine
Volume 27, Issue 4 , pp 395-397
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- 1. University of California Davis School of Medicine (Department of Emergency Medicine) and Betty Irene Moore School of Nursing, Sacramento, CA, USA
- 2. Institute for Population Health Improvement, UC Davis Health System, 4800 2nd Avenue, Suite 2600, Sacramento, CA, 95817, USA
- 3. Case Western Reserve University School of Medicine and Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH, 44106, USA