Letters Section Editor: Robert M. Golub, MD, Senior Editor.
In Reply: Drs Shishehbor and Litaker agree that additional process-of-care measures are needed but raise the issue that current measures do not adjust for patient adherence to prescribed evidence-based therapies. We agree that a care process requires at least some degree of patient adherence in order to influence postdischarge clinical outcomes, and differences in adherence rates are in part responsible for observed disparities between the magnitude of benefit observed in clinical trials (efficacy) and that observed in actual clinical practice (effectiveness).1
Fonarow GC, Yancy CW, Abraham WT, Greenberg BH. Performance Measures and Outcomes for Patients Hospitalized With Heart Failure—Reply. JAMA. 2007;297(14):1547-1549. doi:10.1001/jama.297.14.1548