There has recently been significant discussion among ACR members about quality measurement, reporting, and improvement, especially in the context of the current national debate on healthcare. Some argue that quality reporting is impractical, burdensome to providers, and, most importantly, has not been shown to yield meaningful benefit to patients. They point to the imperfect science of quality measurement that, if improperly implemented, may actually worsen outcomes.1 They suggest that the current rheumatology quality indicators are more apt to improve quality in primary care than rheumatology, and that rheumatologists ought to demonstrate their commitment to quality by using more consequential measures. Many practitioners can’t fathom how they would fit even the most basic measurement into their days. They wonder what happened to physician autonomy in decision making—a skill that involves both science and art, and thus may not be quantifiable.
Over the past decade there has been an increasing awareness that the quality of medical care delivered in the United States is inadequate. Indeed, the Institute of Medicine (IOM) recently concluded that, “The immediate and dominant issue of greatest threat to the health and economic security of Americans is the failure of our healthcare system to deliver the value [quality/cost] that should be expected from the heath care we receive.”2 It is also clear that while per capita expenditures are higher than any other country in the world, healthcare in the United States consistently underperforms when compared with other countries. In its seminal document, the IOM described a quality “chasm.”3 Simply stated, often Americans do not receive the healthcare that they need, and often the care they do receive is not really needed. The recognition of the magnitude of the gap between the care that is delivered and the care that ought to be led to the development of quality-of-care measures and the use of such measures for the purposes of quality improvement. In the recently passed economics stimulus package, billions of dollars were allocated towards initiatives to improve healthcare. While the concerns expressed are all valid, the national imperative to improve healthcare quality is a train that has already left the station. I believe it is the ACR’s responsibility to jump on the train and work to influence its direction on behalf of its members.
Accurate and meaningful measurement of quality of care for rheumatic disease patients is an appealing concept, but the complexity of modern clinical practice makes it difficult.
