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Letters |1 June 1994

Scorecard Medicine—Measuring Process and Outcome

Stephen Clement, MD

Article, Author, and Disclosure Information
Author, Article, and Disclosure Information
  • Major, Medical Corp; Department of the Army; Walter Reed Army Medical Center; Washington, DC 20307-5001 Disclaimer: The opinions and assertions stated here are those of the author and do not represent the views of the Department of the Army or the Department of Defense.
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TO THE EDITOR:
Dr. Brook's editorial [1] and the accompanying article advocate the increased public release of patient outcome data to monitor quality of care. As noted, such a system of scorecard medicine would supposedly answer the question “Do the patients of physician A do better, after controlling for sickness, than those of physician B?”
I immediately thought of five patients in the past week who would probably score low in the “sickness” category but who epidemiologically are at high risk for early death. All are middle-aged men and women with a strong family history of coronary artery disease, hypertension, and non–insulin-dependent diabetes mellitus with evidence of microvascular or macrovascular complications. All have truncal obesity, are sedentary, and smoke. None were able to stay on a diet or exercise regularly despite encouragement by several health care providers. These patients show that overall “sickness” may largely be determined by behavior-related factors.
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Clement S. Scorecard Medicine—Measuring Process and Outcome. Ann Intern Med. ;120:971–972. doi: 10.7326/0003-4819-120-11-199406010-00018

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Published: Ann Intern Med. 1994;120(11):971-972.

DOI: 10.7326/0003-4819-120-11-199406010-00018

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Print ISSN: 0003-4819 | Online ISSN: 1539-3704

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