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March 1, 2008

Understanding the Critical Importance of Diagnosis in the Measurement of Quality of Care

Arch Ophthalmol. 2008;126(3):426-427. doi:10.1001/archopht.126.3.426

The implementation of the 2007 pay-for-performance measures by Medicare has emphasized the importance of quality measures in patients with chronic diseases. Appropriate measures will allow us to assess the quality of care administered and to establish areas of opportunity for improvement. Quality performance may be measured along different dimensions. While “outcomes” of care are the “holy grail” of quality improvement systems, there are many obstacles and issues toward creating fair and appropriate outcomes measures. As such, the 2007 pay-for-performance measures are indicators that focus on processes of care, or the application of predetermined patterns of care to a patient (“doing the right thing at the right time”). For example, a process measure may include whether a patient with hypertension with poor blood pressure control is offered additional antihypertensives or if a patient with diabetes mellitus with proliferative retinopathy is offered surgical or laser treatment. While many other factors may affect the outcome result, good process measures evaluate the appropriateness of the action physicians took and their performance should be related to better outcomes.