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In Reply Dr Zelicoff points to several significant challenges for the development and implementation of successful risk-based quality measures, including limitations of existing risk calculator tools and the ability of clinicians to interpret and communicate statistical risk. We share the sentiment that practical, standardized, and validated approaches to risk calculation and communication are a significant research and educational need.
As Zelicoff effectively illustrates with the example of the FRAX tool for osteoporosis, best practice guidelines are imperfectly applied on the ground—perhaps more so when risk calculation is involved. Yet operational challenges should not lead to jettisoning of best practices. Rather, systems and policy solutions to facilitate a higher standard of care should be sought. In this way, we view the application of quality measures as a tool for driving improvement and promoting accountability, rather than merely a common denominator for assessment.
Stine N, Chokshi D. Multifactorial Risk Assessment for Atherosclerotic Cardiovascular Disease—Reply. JAMA. 2015;313(9):972. doi:10.1001/jama.2015.430