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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-b

To the Editor: In their Commentary, Drs Nolan and Berwick1 argue for an all-or-none performance assessment of quality. They cite the 2004 National Healthcare Quality Report2 that found that only 32.1% of patients with diabetes had all 5 recommended interventions. That study looked at whether patients reported receiving a flu shot, retinal examination, and foot examination in the past year and had a glycohemoglobin and lipid measurement in the past 2 years. Other organizations, such as the Wisconsin Collaborative for Healthcare Quality, are also trying to measure quality by reporting all-or-none scores, such as whether a diabetic patient has had cholesterol screening or measurement of kidney function in the past 12 months.3 This may not be a fair measurement of quality in chronic disease management.

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