He added, "This is a very young and immature science, and that statement's probably more significantly true for outcome measures than for process measures."
Kizer says that for all of the work being done to link such process measures with improved survival, mobility and function, like giving patients serum glucose at 6 a.m. after their cardiac surgery, quality metrics today overlook one enormous ingredient that makes what doctors and hospitals and nurses provide pale in comparison.
"We have to remember that the healthcare that hospitals and doctors provide is only a small piece of what makes people healthy, perhaps only 10%," he says. The rest has to do with family, food, diet, environment, education, lifestyle, and so forth.
And to focus on medical care, without looking at the other 90%, "creates misperceptions about a lot of other things that we should be looking at," Kizer says.
But unfortunately, we're only at the beginning of our search to find quality measures to improve that other 90%, he says.
Let's look at veterans and smoking, two of his favorite topics.
The military tries to reduce smoking among its personnel, and does a good job offering nicotine replacement therapy to active duty members or veterans. But, Kizer says, "They don't offer it—it has been expressly forbidden—to give it to their families.
"So here you have veterans who got off the smoking habit, and we send them back to their families where everyone else is smoking. What's the likelihood they're going to continue to not smoke? Here's a huge cause of morbidity in this country, and a great example of why we cannot treat patients in isolation."
The physician takes care of the hospitalized CHF patient, prescribes medications and sends him home. "But the patient doesn't take the medications, goes out and eats French fries and loads up on salt, and ends up back in the ER within 30 days. Whose responsibility is that?" Kizer asks.