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Letters |

Unreliability of Physician "Report Cards" to Assess Cost and Quality of Care

Kaveh G. Shojania, MD; Robert M. Wachter, MD
JAMA. 2000;283(1):51-54. doi:10-1001/pubs.JAMA-ISSN-0098-7484-283-1-jbk0500.
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To the Editor: Dr Hofer and colleagues1 use the example of diabetes care to provide a convincing demonstration of the limitations of outcomes-based physician profiling and the perverse incentives such profiling may introduce. Although Hofer et al briefly acknowledge the potential virtues of process measurement, both they and Dr Bindman,2 in his editorial, suggest that these limitations undermine the value of all quality measurement activities involving report cards. We argue for a more sanguine view. Appropriately adjusted outcomes may still provide valuable quality measures for acute illnesses and procedures that carry significant short-term risks of morbidity and mortality, such as myocardial infarction3 and cardiac surgery.4 For chronic illnesses, such as diabetes, important outcome differences between providers may take years to accrue, so that focusing on processes of care with proven benefits to patients may be preferable to outcomes-based performance measurement.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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