October 05, 2011

Editorial by NICHQ President and CEO Charlie Homer Published in JAMA

The October 5 issue of the Journal of the American Medical Association includes an editorial by NICHQ president and CEO Charlie Homer, MD, MPH. Dr. Homer reviews the results of a study published in the same issue by Morse and colleagues that examines compliance with asthma quality measures at children’s hospitals and subsequent asthma-related outcomes. The study’s key finding is that discharging patients ages 2 to 17 with a home management plan, a common measure of how well hospitals treat children and teens with asthma, doesn’t reduce readmissions or emergency room use.

Writes Dr. Homer:

“Measurement is one lynchpin for improving quality. Measures – when coupled with the capacity for organizational improvement – can lead to better care. The bar for using a measure should be high. Measurement is costly and burdensome. If organizational leadership uses measures to shift priorities and effect care or if external entities use them to determine payment or accreditation, these parties should be confident that they are measuring the right thing and that outcomes will be better.

“Based on the findings of Morse et al, use of a written discharge management plan no longer meets the criteria for a high-quality measure. Nonetheless, asthma remains the major cause of hospitalizations in childhood in the United States.

“Should hospitals stop providing written management plans when sending a child home with asthma? It seems likely that although written plans alone are insufficient, they may be a valuable part of a more comprehensive transition program.

“Measurement can play a key role in helping redress the shortcomings of the US health-care system, but measures must meet high standards. The study by Morse et al, highlighting the great value of “post-marketing” surveillance of performance measures, demonstrates that an asthma discharge plan no longer reaches this threshold and should be retired.”