“The disconnect between process and outcome measures does raise important questions as to whether we’re measuring the right things on either count,” says Kizer, who now directs the new Institute for Population Health Improvement at University of California at Davis Health System. But hospitals and doctors have to start somewhere if they’re serious about using science to improve care.
“It’s going to be like teaching a pig to dance. It gets you dirty and annoys the pig,” quips Glenn Mitchell, MD, chief medical officer for the Sisters of Mercy Health System, a 28-hospital network based in St. Louis.
“It’s a process,” he says. “And it’s going to be problematic to get it going and figure how it works. But if we can get to actually incenting improvement in patient outcomes, it will all be worth it.”
Mitchell says his leadership teams managing Mercy’s 4,500 acute care beds share his concern—expressed by many health officials and hospital leaders nationally—that how those process measures are done will vary dramatically among providers because many clinicians may try to “game the system.”
Take checklists, he says. “No matter how they’re filled out, they’re not necessarily true. We know of a hospital in our area that strived to get to 100% of the measure to give CHF patients discharge instructions. And by golly they did. They got to 100% because they gave heart failure discharge instructions to every single discharged patient, even if they were in for a nose job.”
Robert Wachter, MD, chief of the division of hospital medicine at the University of California San Francisco, expressed similar concerns.