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Using Clinical Trial Summary Results to Establish Quality Measures—Reply
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In Reply: Ms Yap and Dr Yap raise an important point: overreliance on the summary results of clinical trials leads to performance measures that can harmfully mismeasure quality. If clinical trials do not evaluate individual variations in patient risks and benefits, then the performance measures based on the average results of these trials may frequently mandate discretionary and even contraindicated care for many patients.
Although well-designed performance measures may be the strongest mechanism for promoting more efficient and higher-quality care when performed prudently, simplistic, all-or-nothing, "evidence-based" measures can harmfully prioritize low-value care.1-3 Unfortunately, examples of such poorly designed measures are common. Related to one of the illustrations in our Commentary, 2 new NCQA diabetes performance measures mandate tight control for blood pressure and glucose for all patients with diabetes (glycated hemoglobin <7% and blood pressure <130/80 mm Hg),4 although risk-based analyses have shown that the expected benefits of achieving these . . . [Full Text of this Article]
Rodney Hayward, MD
VA Ann Arbor Healthcare System
Ann Arbor, Michigan
David M. Kent, MD, MSc
dkent1@tufts-nemc.org
Institute for Clinical Research and Health Policy Studies
Tufts-New England Medical Center
Boston, Massachusetts
RELATED LETTER
Using Clinical Trial Summary Results to Establish Quality Measures
Tracey L. Yap and Winston Y. Yap
JAMA. 2007;298(23):2740-2741.
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RELATED ARTICLE
Limitations of Applying Summary Results of Clinical Trials to Individual Patients: The Need for Risk Stratification
David M. Kent and Rodney A. Hayward
JAMA. 2007;298(10):1209-1212.
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