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Letters |1 June 1994

Scorecard Medicine—Measuring Process and Outcome

Robert H. Brook, MD, ScD

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Author, Article, and Disclosure Information
  • University of California, Los Angeles, Center for the Health Sciences; Los Angeles, CA 90024
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IN RESPONSE:
I agree with Dr. Clement that, unless publicly released data on quality are accurate, untoward events may occur. In particular, physicians who perceive that outcome-based systems do not adequately adjust for sickness at the time of treatment may stop caring for sick patients to improve their performance profiles. One solution is to build severity adjustment models that “overadjust” for sickness (that is, give physicians who care for sicker patients extra credit in terms of expected mortality).
Patients' habits that affect outcome, such as smoking [1], weight [2], and even exercise, can be measured and included as adjustors in outcome models. Because self-reports would be anonymous, confidential, and not used for determining eligibility for life or health insurance, patient responses should not be biased.
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Brook RH. Scorecard Medicine—Measuring Process and Outcome. Ann Intern Med. ;120:971–972. doi: 10.7326/0003-4819-120-11-199406010-00019

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

DOI: 10.7326/0003-4819-120-11-199406010-00019

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

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