Stephen D. Persell, MD, MPH; Nancy C. Dolan, MD; Elisha M. Friesema, BA; Jason A. Thompson, BA; Darren Kaiser, MS; David W. Baker, MD, MPH
Grant Support: By the Agency for Healthcare Research and Quality (grant 1R18HS17163-01). Dr. Persell was supported by a career development award (1K08HS015647-01) from the Agency for Healthcare Research and Quality.
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M09-1382.
Requests for Single Reprints: Stephen D. Persell, MD, MPH, Division of General Internal Medicine, Northwestern University, 750 North Lake Shore Drive, 10th Floor, Chicago, IL 60611; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Persell: Division of General Internal Medicine, Northwestern University, 750 North Lake Shore Drive, 10th Floor, Chicago, IL 60611. Dr. Dolan: Northwestern Medical Faculty Foundation, 675 North Saint Clair Street, Chicago, IL 60611.
Ms. Friesema, Mr. Thompson, and Dr. Baker: Northwestern University, 750 North Lake Shore Drive, 10th Floor, Chicago, IL 60611.
Mr. Kaiser: Northwestern Medical Faculty Foundation, 680 North Lake Shore Drive, 11th Floor, Chicago, IL 60611.
Author Contributions: Conception and design: S.D. Persell, N.C. Dolan, E.M. Friesema, D. Kaiser.
Analysis and interpretation of the data: S.D. Persell, N.C. Dolan, E.M. Friesema, J.A. Thompson, D.W. Baker.
Drafting of the article: S.D. Persell, N.C. Dolan, D.W. Baker.
Critical revision of the article for important intellectual content: N.C. Dolan, D. Kaiser, D.W. Baker.
Final approval of the article: S.D. Persell, N.C. Dolan, D.W. Baker.
Provision of study materials or patients: N.C. Dolan.
Statistical expertise: S.D. Persell, N.C. Dolan.
Obtaining of funding: N.C. Dolan, D.W. Baker.
Administrative, technical, or logistic support: S.D. Persell, N.C. Dolan, E.M. Friesema, D. Kaiser, D.W. Baker.
Collection and assembly of data: S.D. Persell, N.C. Dolan, E.M. Friesema, J.A. Thompson, D. Kaiser.
Persell S., Dolan N., Friesema E., Thompson J., Kaiser D., Baker D.; Frequency of Inappropriate Medical Exceptions to Quality Measures. Ann Intern Med. 2010;152:225-231. doi: 10.7326/0003-4819-152-4-201002160-00007
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Published: Ann Intern Med. 2010;152(4):225-231.
Performance measurement coupled with feedback (that is, audit and feedback) to health care providers has been shown to improve the quality of care (1). Computerized clinical decision support can also improve quality (2, 3). However, even when these methods are successful, the gains have generally been minimal, and quality usually remains far less than ideal.
Feedback to providers seems less effective when performance is already fairly good (1), and this may be true even when financial incentives are awarded on the basis of performance (4). As quality improves, an increasing proportion of apparent quality deficits—identified by clinical decision-support systems or on performance reports—may actually be incorrect. Valid medical exceptions explain these deficits (5–10). If physicians believe that the tools used to measure their performance are incorrect, they may not heed decision support or they may dismiss the results of performance reports, even if they are not achieving the desired results.
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Cardiology, Endocrine and Metabolism, Diabetes, Healthcare Delivery and Policy, Coronary Risk Factors.
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