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Editor's Note
September 9, 2013

Performance MeasuresBetter Outcomes, Not Better Grades

JAMA Intern Med. 2013;173(16):1549. doi:10.1001/jamainternmed.2013.7769

Performance measures are widely used with the goal of improving care of patients with heart failure and other illnesses. This study by Dharmarajan et al illustrates that performance measures may sometimes have unintended consequences. The authors show that in the enthusiasm to achieve the measure of placing patients with heart failure on β-blocker therapy at hospital discharge, many patients who should not receive β-blockers are getting them, while others who meet the criteria are not. It is likely that there was more thoughtful discussion and decision making behind these decisions that is not captured in administrative data used for this analysis. However, it must also be remembered that the purpose of performance measures is to improve patient care, not to get high grades. Too much focus on meeting a target can distract us from the care of the whole patient.