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Performance measurement and clinical accountability are important.
But
who are the people doing the measuring and accounting, how reliable
are their sources, and who are they accountable to?
I recently received a computerized letter from a state agency (one
that I
had never heard of before) berating me for my poor care of a diabetic
patient. It stated that he had not had his lipids checked in the past year
(he has), has not had a microalbumin screen (he has), has not had a
formal eye exam by a specialist (he has), and has not had at least two
HbA1c's done in the past year (guilty as charged - but he came to my
practice 6 months ago from another practice where he had not had one
done in the past 4 years; since coming to me he has had one HbA1c
drawn and failed to keep his appointment to had the second one drawn).
In addition it states that I had failed to follow the standard
recommendation that all diabetics have a TSH drawn each year - which
is true, but who this recommendation comes from I have no idea (it is
certainly not in the American Diabetes Association standards of care),
and it is not at all clear that his insurer would pay for it.
This goverment agency did not invite feedback or correction.
Presumably
his poor care is now in some database as yet another example of
physicians' noncompliance with proper standards of care, and
contributes to some aggregate national or state statistic attesting to
this, and presumably I am now in some database as a poor caregiver.
To whom are the accounters accountable?
Performance measurement and clinical accountability are important.
But
who are the people doing the measuring and accounting, how reliable
are their sources, and who are they accountable to?
I recently received a computerized letter from a state agency (one
that I
had never heard of before) berating me for my poor care of a diabetic
patient. It stated that he had not had his lipids checked in the past year
(he has), has not had a microalbumin screen (he has), has not had a
formal eye exam by a specialist (he has), and has not had at least two
HbA1c's done in the past year (guilty as charged - but he came to my
practice 6 months ago from another practice where he had not had one
done in the past 4 years; since coming to me he has had one HbA1c
drawn and failed to keep his appointment to had the second one drawn).
In addition it states that I had failed to follow the standard
recommendation that all diabetics have a TSH drawn each year - which
is true, but who this recommendation comes from I have no idea (it is
certainly not in the American Diabetes Association standards of care),
and it is not at all clear that his insurer would pay for it.
This goverment agency did not invite feedback or correction.
Presumably
his poor care is now in some database as yet another example of
physicians' noncompliance with proper standards of care, and
contributes to some aggregate national or state statistic attesting to
this, and presumably I am now in some database as a poor caregiver.
Competing interests:
None declared
Competing interests: No competing interests