To the Editor: In their Commentary, Dr Pronovost and colleagues1 discussed generally accepted accounting principles (GAAP) and quality measurement. Although we agree that a standardized reporting system using GAAP as a model is a good idea in theory, there are several cautionary lessons from a relatively simple system like accounting to keep in mind when compared with the complexities of quality assurance measurements in medicine.
Information conveyed in external reports may lack detail required by internal reports, and vice versa. Therefore, the level of detail to be included in a GAAP-style report must be specified for either external or internal audiences. It is not unusual for basic financial statements that consist of a balance sheet, income statement, statement of changes in equity, and statement of cash flows (often 4 pages) to be followed by a footnote section that can be more than 20 pages long.2 Companies may also have to comply with several external standards that differ from GAAP, such as one for the Securities and Exchange Commission and another for Medicare.3 Even in accounting, where the data are relatively straightforward, there are lively debates about the superiority of GAAP vs the International Accounting Standards used outside of the United States and Canada4 - 5 ; a similar trans-Atlantic debate about performance indicators for medicine would likely be even more contentious.
The demands of substantive relevance and timeliness are likely to be harder to satisfy in medicine than in finance because technology and treatments change rapidly. Therefore, a GAAP-style system for medicine has to be relatively flexible and responsive. The information must also be reliable and comparable between sites and therefore must involve building consensus, similar to the process for GAAP, because a potential major pitfall of a standardized reporting system is the ability to misrepresent under the veil of standardization. Finally, to set up a verification system, detailed cost-benefit and cost-effectiveness analyses would be necessary to avoid causing net harm by pulling limited resources away from other opportunities.
Financial Disclosures: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
Instructions
Comments are moderated and will appear on the site at the discretion of the Journal of American Medical Association editors. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest* Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Customize your page view by dragging & repositioning the boxes below.
and access these and other features:
Register Now
Enter your username and email address. We'll send you a reminder to the email address on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.