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Letters
July 26, 2006

All-or-None Measurement of Health Care Quality

Author Affiliations
 

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2006;296(4):392-393. doi:10.1001/jama.296.4.392-a

To the Editor: In their Commentary, Drs Nolan and Berwick1 advocate the widespread adoption of all-or-none measures in the assessment of health care quality. The all-or-none measure works in a multiplicative sense, compared with composite measures that are additive. For example, for diabetes care they note 5 activities that could be measured by a present/absent indicator and recorded as 1 (present) and 0 (absent). The all-or-none score for 3 possible patients would be calculated as: patient A: 1 × 1 × 1 × 1 × 1 = 1; patient B: 1 × 0 × 1 × 1 × 1 = 0; and patient C: 0 × 0 × 0 × 0 × 0 = 0.

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