This visit got me thinking on the topic of provider and program accountability which led me to this opinion article, published by the Joint Commission, in Annals of Internal Medicine. I highly recommend giving it a perusal.
The four critical criteria for accountability measures that address health outcomes are as follows:
- Strong evidence should exist that a particular intervention or bundle leads to an improvement in the outcome
- The outcome should be measurable with a high degree of precision
- A risk adjustment methodology should exists and include and accurately measure the risk factors most strongly associated with the outcome
- Implementation of the outcome measure must have little chance of causing adverse consequences
So how well do we fare when applying the above criteria to proposed outcomes? Not so great. Check out table 2 in the manuscript. Central line bloodstream infection outcomes meets the criteria as does NSQIP surgical site infection reduction programs.
In my opinion, Clostridium difficile outcome measures fall far short on criteria #1.
As for CMS Hospital Compare data it systematically violates criteria # 3, risk adjustment.
A major flaw.
We need to be cautious when outcomes drive accountability.