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How Do Guidelines Impact Measures of Performance? Can They Keep Up?  Comment on “Monitoring Performance for Blood Pressure Management Among Patients With Diabetes Mellitus”

Eileen Handberg, PhD
Arch Intern Med. 2012;172(12):945-946. doi:10.1001/archinternmed.2012.2261.
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Improving quality of health care delivery has been a major focus since the publication of the Institute of Medicine report “Crossing the Quality Chasm.”1 While concerns about funding and access to quality health care have not been resolved, there is overwhelming agreement that the foundation of efforts to improve care is predicated on outcomes measurement.2

Since the 1980s, 2 professional societies, the American College of Cardiology (ACC) and the American Heart Association (AHA), have collaborated on guidelines for cardiovascular disease (CVD). The methodology is a rigorous, systematic, peer-review process of scientific evidence to develop documents that guide practice.3 Performance measures developed for CVD are the logical progression following implementation of guidelines as an indicator of quality of delivered care. Similar rigorous methodology for performance measures was developed by the ACC/AHA Task Force on Performance Measures in 2000.2 Categorized as either “performance measures” or “quality measures,” performance measures are designated as appropriate for both quality improvement and external reporting and quality measures are those appropriate for quality improvement and not for external reporting until further validation and testing. Performance measures are complex and, in the case of cardiac risk factors such as hypertension and lipid levels, have to address whether patients are “treated” and whether they achieve “control.” All measures have limitations and pose challenges to ensure that they are accurate reflections of intended outcomes, ie, measurement of blood pressure (BP) control. Reporting of performance measures is crucial to ensure that care is appropriately evaluated, modified, and improved to ensure that patients receive the highest levels of quality care.

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