First, she says, there is wide disagreement among those who design and vet quality metrics about which ones add value. "There's still debate in Washington about which measures will actually improve outcomes," she says. "If it were easy, we would have agreed by now."
Her second concern is that getting a high score does not allow for "positive deviance." That's when clinicians discover that a particular process just isn't appropriate for a certain group of patients, and "try something else and find they get a better outcome."
Correcting blood glucose levels in patients during operations or giving beta blockers to patients with suspected heart attacks are two such examples. When performed in certain groups of patients, they can result in unintended consequences, Conroy says.
She says that teaching hospitals do take these process measures seriously. "But once we get into composite measures and scoring, it becomes another contest around ratings and you have to wonder if you're really improving care," she says. She thinks that's one reason why so few academic medical centers made the list.
Asked why academic medical centers were prominently absent from the list, Jerod Loeb, PhD, Executive Vice President, Division of Research for the Joint Commission replied in an e-mail:
"Academic health centers are very complex places and, often because of that complexity, routine processes can fall through the proverbial cracks. However, at the end of the day, the processes we measure are based on sound clinical evidence that the given process, if followed (and there are no contraindications), is essential for good patient outcomes. There are – or should be – no excuses."