Letters Section Editor: Robert M. Golub, MD, Senior Editor.
In Reply: Dr Van Matre offers an example of measuring diabetes care using 5 elements for patients A, B, and C. Patient A receives all needed care; patient B receives almost all needed care; and patient C receives none of the 5 elements. If we wish to focus on comparing patient B with patient C, then as Van Matre correctly states the particular all-or-none measure we used as an illustration in our article would not be helpful. An all-or-none measure with different elements (including, for example, the availability of access to affordable care) would be more suitable. The focus in our illustrative example of the all-or-none approach was to highlight the differences in care between patients A and B. More generally, as is true of all metrics, any specific all-or-none measure will be useful for some purposes and not for others.
Nolan TW, Berwick DM. All-or-None Measurement of Health Care Quality—Reply. JAMA. 2006;296(4):392-393. doi:10.1001/jama.296.4.393-a