The Flip Side of Performance Measures:  Comment on “The Other Side of Quality Improvement in Diabetes for Seniors”

Almost all performance measures are based on recommendations to do something—screen for cancer; reduce blood pressure, lipoprotein levels, or glycohemoglobin values; and start treatment with medications that reduce risk among persons with conditions such as coronary disease or congestive heart failure. Used in appropriate patients in the correct circumstances, these interventions have been shown to be beneficial. However, there is also ample evidence that overtreatment is harmful in many patients, especially those who are older and have other illnesses. In this issue of the Archives, Pogach and Aron suggest a performance measure that would penalize physicians and health care systems for a glycohemoglobin concentration of less than 7% among persons with diabetics who are older than 65 years and at risk for hypoglycemia. This measure of overtreatment and other similar measures have great potential to limit the adverse effects of overtreatment and to improve health.