Letters Section Editor: Robert M. Golub,
MD, Senior Editor.
In Reply: We agree with Dr Pawlson and colleagues
and Drs Fleming and Petzel that using a random sample of patients will improve
the CRC screening performance measure, and we are delighted that the VHA has
made this change. However, we disagree that sample selection was the only
problem needing correction. In our article we discussed the need for better
measures that consider not only who received testing for CRC, but why it was
done and whether the patient wanted it. Pawlson et al make several assumptions
that diagnostic tests and refusals will be randomly distributed across samples
from different facilities and therefore will not affect target rates (benchmarks).
We believe these are tenuous and untested assumptions that require further
research to determine whether they are true. Since VHA performs chart reviews,
it has a unique opportunity to validate these assumptions.
Walter LC, Heineken PA, Covinsky KE. Pitfalls of Converting Practice Guidelines Into Quality Measures—Reply. JAMA. 2004;292(11):1301. doi:10.1001/jama.292.11.1302-a