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Pronovost: Surveillance Bias Threatens Quality Payment Fairness

Cheryl Clark, for HealthLeaders Media, June 15, 2011

A serious problem of 'surveillance bias' threatens the fairness of quality incentive payments and therefore, the integrity of public reporting about harm, say infection checklist pioneer Peter Pronovost, MD, and his Johns Hopkins research colleague Elliott R. Haut, MD.

In a commentary published Tuesday in the Journal of the American Medical Association, the researchers say that some hospitals may appear better or worse than their competitors because of faulty data that appears when hospitals look harder, and therefore find more evidence of complications in their patients.

"Performance measurement is essential for improving quality and reducing costs of medical care," they wrote. "However, most outcome measures in use do not sufficiently standardize surveillance for events and those at risk for events, likely introducing substantial measurement error."

They give the example of screening for deep vein thrombosis, a condition that is labeled as hospital-acquired when it occurs in orthopedic or other procedures. In those cases, Medicare won't pay hospitals for additional care that those avoidable outcomes require.

"Everyone wants to know, 'What is the best hospital?' "Where should I have my surgery?' Haut said in a news release. "People want to compare hospitals, but if the science can't keep up, maybe we're doing more harm than good when we report certain kinds of data. It raises a different question: Are the numbers being reported meaningful?"

Without standardizing the way hospitals look for these complications, data that points to better or worse quality care "may be worthless," he said.

DVT is a common, life-threatening complication that can occur with greater frequency in trauma patients, and some clinicians use duplex ultrasound to screen trauma patients even if they are asymptomatic.

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