Refining Quality Measurement Programs

Research reported in the Annals of Internal Medicine examines exception reporting in regard to quality of care guidelines.  (Annals Article) (Abstract Only)  Increasingly physicians and hospitals are measured on quality of care guideline performance.  There can be legitimate exceptions to following the guidelines for particular patients.  If exceptions cannot be reported and taken into account in the measurement process, physicians may be inclined to follow them even when they shouldn’t, particularly if incentives or penalties may apply.  If exceptions can be reported, physicians might use them inappropriately to improve their scores.

In this study of one large academic medical practice with an EHR, online exception reporting was built in.  The researchers did a peer review of exception reporting.  They reviewed over 600 exceptions to quality guidelines for CHD, diabetes, health failure and prevention and screening.  Almost 94% were judged appropriate and only 3% clearly inappropriate.   Physicians were provided feedback on the inappropriate exceptions and about half the time changed their management of the patient.

The researchers note the importance of exception reporting, but acknowledge that their method of reviewing its appropriateness is not practical in daily clinical practice.  They suggest building exception reporting edits into EHRs or limiting peer review to measures where inappropriate exceptions have been found to commonly occur.    One advantage of improving exception reporting is that it gives a truer picture of actual appropriate compliance with quality guidelines.