What doctor would take measures to keep a dying patient alive for a few extra weeks to avoid a "worse than US national rate" scold on the Hospital Compare website? Still, regardless of what drove the timely spike in cardiac surgery deaths, the study raises the issue: What are the unintended consequences of quality of care and performance measures?
Actions 'Not in the Patients' Best Interest'
A qualitative study from the University of Minnesota attempted to answer that question by looking at performance measures for primary care at Veterans Administration hospitals. Using at data from 2009, the researchers, led by Katie White, EdD, MBA, looked at screening measures for obesity, hypertension, cancer, vascular disease, diabetes, mental health and substance use.
They interviewed primary care staff and facility leaders to help "identify unintended consequences and explore the pathways by which they arise." The research, published last year, uncovered a type of clinical care providers described as "'treating the measure, not the patient.'
A key finding: "The perception that performance scores must be improved or that a provider or clinic is not in compliance with expected targets can lead providers to take actions when they are not in the patient's best interest." Examples include overuse of medications to improve blood pressure. In some cases, the time it takes to deal with performance measure prevents providers from addressing "unmeasured, but important aspects of patient care," the researchers wrote.