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September 15, 2004

Pitfalls of Converting Practice Guidelines Into Quality Measures—Reply

Author Affiliations

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

JAMA. 2004;292(11):1301. doi:10.1001/jama.292.11.1302-a

In Reply: We agree with Dr Pawlson and colleagues and Drs Fleming and Petzel that using a random sample of patients will improve the CRC screening performance measure, and we are delighted that the VHA has made this change. However, we disagree that sample selection was the only problem needing correction. In our article we discussed the need for better measures that consider not only who received testing for CRC, but why it was done and whether the patient wanted it. Pawlson et al make several assumptions that diagnostic tests and refusals will be randomly distributed across samples from different facilities and therefore will not affect target rates (benchmarks). We believe these are tenuous and untested assumptions that require further research to determine whether they are true. Since VHA performs chart reviews, it has a unique opportunity to validate these assumptions.