In today’s Annals of Internal Medicine, my colleagues and I describe the saga of the four-hour measure of door-to-antibiotics time for pneumonia – the first truly dangerous measure in the era of public quality reporting. It is an important cautionary tale. As I’ve discussed previously, the biggest surprise of the last decade in the quality field ...

Last week, Medicare added patient satisfaction data to its hospital reporting website. This is progress, but it raises an interesting question: should patient satisfaction scores be case-mix adjusted?The motivation to include patient satisfaction data comes from the Institute of Medicine’s inclusion of “patient-centeredness” as one key component ...

In this month’s issue of the Joint Commission Journal of Quality and Patient Safety, I (with UCSF’s Adams Dudley and the American Hospital Association's Nancy Foster) tackle this provocative question. The answer may surprise you: yes (probably). The devil will be in the details.I hope you’ll have a chance to read the full article (the Joint ...

Stuff this week that caught my eye: Does medical tourism harm the natives? Are all those CT scans destroying more than our budgets? Are nocturnalists at risk for more than decubs? Will Medicare need to cut hospital payments to fuel P4P? Answers: yes, yes, probably, and duh.Yesterday, NPR’s All Things Considered described the dark side of medical ...

Just a quick heads up re: an article that Peter Pronovost (the world's best patient safety researcher, in my judgment), Marlene Miller (both of Johns Hopkins) and I have in today's JAMA. In it, we argue that there is now suffficient skin in the quality game that the time has come for there to be a...stronger environment to help protect patients, ...

At my just-completed annual hospital medicine CME course, we held a fascinating session on the future of quality measurement, transparency, and pay for performance (P4P). The discussants – Andy Auerbach, Peter Lindenauer, and Kaveh Shojania – all emphasized the limits of process measurement, particularly noting the problems of unforeseen ...

P4P (pay for performance) is all the rage in healthcare. And why not? In the face of the damning evidence that we ''get it right'' only about half the time, criticizing linking higher payments to better care seems frankly un-American. And there is accumulating evidence that P4P may work. A study earlier this year by my friend Peter Lindenauer ...