Clinically Complex Veterans have Higher Rates of Performance Measurement and Higher Satisfaction with Care
Performance measurement has been widely adopted to improve quality of care, but one potential limitation is in being able to measure all of the important aspects of care. For example, measures of clinical care are limited to what is measurable, and what is measurable is not always what’s most important. Clinically complex patients (those with more than one condition/disease) may be particularly vulnerable because they often have needs that are unmeasured, and those needs may compete with time for performance measures. This observational study examined the relationship between measured performance and satisfaction with care among clinically complex VA patients. Investigators analyzed a national sample of 35,927 veterans who received outpatient VA care in FY03 and FY04, looking at performance measures such as: breast and colorectal cancer screening, influenza and pneumococcal vaccination, lipid monitoring, eye examination for veterans with diabetes, and the use of ACE inhibitors for veterans with heart failure. Investigators also assessed patients’ satisfaction with care.
Findings show that veterans with higher clinical complexity had higher measured performance on common process measures used to assess the quality of outpatient care. In addition, satisfaction with care was higher among clinically complex patients with high measured performance, suggesting that compliance with performance measures does not crowd out unmeasured care.
Werner R and Chang V. The relationship between measured performance and satisfaction with care among clinically complex patients. Journal of General Internal Medicine November 2008;23(11):1729-35.
This study was partly funded by HSR&D. Dr. Werner is supported by an HSR&D Career Development Award. Authors are part of HSR&D’s Center for Health Equity Research and Promotion in Philadelphia.