Who is watching the watchmen: Is quality reporting ever harmful?

Area of Science:

• Health services research
• Health economics
• Biostatistics

Background:

• Quality reporting incentivizes healthcare providers to improve patient outcomes.
• Current systems may lead to unintended consequences like patient cherry-picking or underpowered comparisons.
• No established minimum accuracy standards exist for quality reporting measures.

Purpose of the Study:

• To delineate minimal accuracy standards for quality measures.
• To establish a prerequisite for effective and ethical quality reporting.

Main Methods:

• A decision analytic model was employed.
• Simplified assumptions were used to illustrate minimal standards.

Main Results:

• A minimal accuracy level was identified to ensure quality reporting "does no harm."
• This threshold depends on the gain in health-related quality of life versus patient switching behavior.
• Optimal system performance (sensitivity and specificity of 1) was assumed.

Conclusions:

• Quality measurement systems must demonstrate improved health outcomes.
• A specific standard of measurement accuracy is necessary for systems not yet proven to enhance health.
• Ensuring accuracy is crucial to prevent harm from quality reporting initiatives.