A review of process measures endorsed by the National Quality Forum (NQF) and published Feb. 3 as a research letter in the Journal of the American Medical Association found that NQF measures focus predominantly on management of patients with established diagnoses, while the prediagnostic care of patients is rarely assessed and measures “infrequently reflect the most common reasons patients seek care.”

Hemal K. Kanzaria, MD, of the University of California, Los Angeles, and colleagues examined 313 NQF-endorsed process measures pertaining to evaluation/diagnosis or management. Of these, 211 (67 percent) began with an established diagnosis, compared to 14 (4.5 percent) that started with a sign/symptom. According to the authors, the 14 sign/symptom-based measures focused on geriatric care or emergency department care, while more common reasons for treatment like fever, cough, headache, shortness of breath, earache, rash, and throat symptoms, were not reflected by the quality measures.

Given the focus of health care reform efforts on improving value partly through controlling use of services, the authors suggest “using a comprehensive set of endorsed sign/symptom-based measures could help patients receive timely care as payment models are changed and may prevent financial incentives from resulting in underuse of necessary care.”  However, they caution that “efforts to develop valid sign/symptom-based quality measures will be challenging.”

Keywords: American Medical Association, Cough, Dyspnea, Earache, Emergency Medical Services, Emergency Service, Hospital, Emergency Treatment, Exanthema, Fever, Headache, Health Care Reform, Health Services Needs and Demand, Motivation, Pharynx, Process Assessment, Health Care

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