Quality metrics not always based on evidence, peer-reviewed methods

With a shift toward value-based purchasing, quality measurements are becoming more popular and prevalent. However, some of the quality measures have been introduced without enough evidence to validate their effectiveness, according to an analysis.

Michele L. Esposito, MD, of Tufts Medical Center in Boston, and colleagues published their findings online March 24 in the Journal of General Internal Medicine.

For instance, they noted that using perioperative beta-blockers (PBBs) in noncardiac surgery and intensive insulin therapy for critically ill patients became quality measures before large, randomized trials proved they were ineffective.

The Centers for Medicare & Medicaid Services (CMS) now offers incentive payments to hospitals for 25 quality measures. They earn extra money for improving their quality of care and meeting or exceeding standards.

The researchers mentioned 100 million patients undergo noncardiac surgery each year, while major cardiac events occur in 10 percent to 40 percent of the operations. PBBs were first introduced in 1973 to be used before surgery and help reduce mortality in these patients.

In 2008, a randomized trial with more than 8,000 patients found those who received beta-blockers had a significant increase in mortality compared with a placebo group. However, the American College of Cardiology/American Heart Association guidelines continued to recommend PBBs, according to the researchers.

Esposito et al also noted the CMS Hospital Readmissions Reduction Program penalizes hospitals for higher than expected 30-day readmission rates for heart failure, acute MI and pneumonia. However, they mentioned higher readmission rates may be out of providers’ and hospitals’ control and may be due to lower socioeconomic status, mental illness and social support.

“Given the potential for adverse consequences, the conversion of guidelines into performance measures should not occur without adequate high-quality evidence,” the researchers wrote. “Although the past decade will undoubtedly be remembered for the gains made in patient safety and quality of care, continued improvement will require greater attention to the principles of scientific rigor in assessing measures of patient care quality and safety.”