Medical exceptions to quality measures are usually justified

January 01, 0001

Medical exceptions to quality measures are usually justified

These US authors implemented computerized decision support with mechanisms to document medical exceptions to quality measures and to perform peer review of exceptions and provide feedback when appropriate. A peer-review panel judged medical exceptions to 16 chronic disease and prevention quality measures as appropriate, inappropriate, or of uncertain appropriateness. Medical records were reviewed after feedback was given to determine whether care changed.

They found: "Physicians recorded 650 standardized medical exceptions during 7 months. The reporting tool was used without any medical reason 36 times (5.5%). Of the remaining 614 exceptions, 93.6% were medically appropriate, 3.1% were inappropriate, and 3.3% were of uncertain appropriateness. Frequencies of inappropriate exceptions were 7 (6.9%) for coronary heart disease, 0 (0%) for heart failure, 10 (10.8%) for diabetes, and 2 (0.6%) for preventive services. After physicians received direct feedback about inappropriate exceptions, 8 of 19 (42%) changed management. The peer- review process took less than 5 minutes per case, but for each change in clinical care, 65 reviews were required. The findings could differ at other sites or if financial incentives were in place."

The authors concluded: "Physician-recorded medical exceptions were correct most of the time. Peer review of medical exceptions can identify myths and misconceptions, but the process needs to be more efficient to be sustainable. Primary Funding Source: Agency for Healthcare Research and Quality."

Reduced peer review effort for quality measures seems appropriate in light of these results, at least when there are no financial incentives in place.

For the full abstract, click here.

Annals of Internal Medicine 152(4):225-231, 16 February 2010
© 2010 to the American College of Physicians
Frequency of Inappropriate Medical Exceptions to Quality Measures. Stephen D. Persell, Nancy C. Dolan, Elisha M. Friesema, Jason A. Thompson, Darren Kaiser, and David W. Baker. Correspondence to Dr. Persell: [email protected]

Category: HSR Health Services Research. Keywords: quality measures, chronic disease, preventive care, decision support, peer review, observational study, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 9 March 2010

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