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Policy maker efforts to evaluate the quality and costs of health care have stimulated a proliferation of disparate performance measures. This cacophony of performance measures creates confusion over which measures are applicable at which level of the health care system, limiting their effective application for accountability and improvements in patient care. The American College of Physicians (ACP) has created a clinical performance measurement framework to provide direction to policy makers and measure developers for future performance measure development and application. The ACP believes that this clinical performance measurement framework is one way to help promote transformational change in patient care through judicious application of performance measures. Recommendation. The ACP recommends that policy makers and measure developers adopt this clinical performance measurement framework to promote transformational change and improve the quality of health care in the United States. [ABSTRACT FROM AUTHOR]

The article presents a study which examined the effect of a team-oriented, practice-based quality improvement program on primary care for patients with increased risk of cardiovascular disease. Team members and internal medicine practices participated in the program that used a pre-post intervention design and focused on measures related to cardiovascular risk factors. Practices showed significant improvement in counseling for diet, exercise, and weight loss. It was found that the use of aspirin, statins, and flu vaccine also increased.

The article offers the author's insights on the profession of medicine and the obligation of medical practitioners to their patients and the public. He discusses the importance of The American Board of Physical Medicine and Rehabilitation (ABPMR) which was created to certify physicians based on the standards of excellence. The author emphasizes the significance of board certifications to provide assurance to the public of a high-quality health care given to patients.

Background: Measures based on the use of either antiinflammatory and/or reliever medications have been used to evaluate clinical performance in asthma.Objective: We compared the association between 2 asthma prescription measures (APMs) and subsequent risk of emergency department (ED) asthma visits.Design: We conducted a cross-sectional analysis of automated pharmacy and healthcare utilization data from 3 large geographically diverse managed care organizations.Participants: We studied children, 3 to 15 years of age, with at least 1 encounter for asthma (hospitalization, ED, or ambulatory care), at least 1 dispensing of an asthma medication, and continuous enrollment between June 1996 and July 1997.Measures: Two performance measures were derived for patients with persistent asthma: 1) the proportion of individuals who have received controller therapy and 2) the ratio of dispensed controller to dispensed reliever medications. Children with persistent asthma were identified using the Health Employers Data Information System (HEDIS) criteria of the National Committee on Quality Assurance definition. Multivariate logistic regression was used to assess independent effects in models for ED visits.Results: Among children with persistent asthma, the dispensing of a controller was associated with a significantly lower risk of an ED visit as compared with children not dispensed a controller (odds ratio, 0.3; 95% confidence interval, 0.2-0.4). An association between the ratio of controller to reliever dispensing and the risk of subsequent ED visit was also observed, however, the underlying level of reliever dispensing modified the relationship. Among children with persistent asthma, the ratio of controller to reliever dispensing was inversely associated with risk of ED visit among children dispensed <4 relievers/person-year but no significant relationship was seen among children dispensed > or =4 relievers/person-year.Conclusion: Among children with persistent asthma, the use of an asthma prescription measure (APM) can help stratify children based on their risk of future adverse events. The HEDIS measure, the dispensing of a controller medication among a population with persistent asthma, and the controller to reliever ratio are associated with the risk of subsequent ED visit. However, the association between the ratio measure and risk for ED visit is modified by the underlying level of reliever dispensing. [ABSTRACT FROM AUTHOR]

Purpose of Review: In spite of numerous efforts, asthma rates in the United States remain historically high and disparities persist among low-income and minority populations. This review assesses the current status of asthma inequities from the perspective of disease development, progression, and outcomes., Recent Findings: Recent findings highlight the complex and multifactorial nature of asthma. There is a clear line of emerging evidence suggestive of important hierarchical relationships between the predisposed or affected individual and his or her intrapersonal life, familial relationships, social networks, and broader community., Summary: Approaches in basic, clinical, and translational asthma research must be modified to account for the social construct of race and to detangle complex interactions of contributing factors at and across the individual and community level. However, there are a number of obvious opportunities to dramatically reduce asthma disparities at hand.

Background: The use of physician profiles in "pay for performance" initiatives depend on their reliability and accuracy., Objectives: To evaluate whether health care delivery units (practices) can be reliably differentiated using the Health Employers Data Information System (HEDIS) performance measure., Research Design: Simulation was used to describe the relationship between practice size (number of children with persistent asthma) and precision of practice measures to estimate performance., Subjects: Children enrolled in 1 of the 39 practice groups from 1 of 3 managed care organizations participating in the Pediatric Asthma Care Patient Outcomes Research Team (PAC PORT)., Measures: The main outcome was reproducibility of 4 performance measures, the HEDIS measure and 3 additional measures available from automated claims data: the proportion of children with asthma related-hospitalization, emergency department visits and oral steroid dispensings for asthma., Results: The ability to reproducibly rank a practice is dependent on the performance measure, practice size, and the reproducibility threshold chosen. Of measures evaluated, none achieved a reproducibility >85% for practice size of 50 or less. At a practice size of 100 subjects, the HEDIS measure reproducibly ranked practices 89% of the time, compared with 85% for emergency department visits and 83% for hospitalizations. Only at a practice size of 100 children with persistent asthma, was reproducibility of ranking greater than 85% with all performance measures evaluated., Conclusions: The reliability of ranking medical practices depends on practice size. Only at the level of the health care organization can asthma measures, available within claims data, be used to rank performance reliably.

Objectives: In February 2002, the Department of Veterans Affairs (VA) raised medication copayments from $2 to $7 per 30-day supply of medication for certain veteran groups. We examined the impact of the copayment increase on medication acquisition from VA., Methods: This was a retrospective cohort study using data from national VA databases from February 2001 through February 2003. We took a random sample of over 5% of male VA users in 2001. Of 149,107 veterans sampled, 19,504 (13%) had copayments for no drugs, 101,410 (68%) had copayments for some drugs, and 28,193 (19%) had copayments for all drugs. We used multivariable count models to examine changes in the number of 30-day medication supplies after the increase., Results: After the copayment increase, veterans subject to copayments for all drugs received 8% fewer 30-day supplies of medication annually relative to veterans with no copayments (P < 0.001). The effect of the copayment increased as the number of different medications veterans received increased. Among veterans subject to copayments for all drugs, acquisition of lower-cost drugs fell by 36%, higher-cost medications fell by 6%, over-the-counter medications fell by 40%, and prescription-only medications fell by 4% relative to veterans with no drug copayments., Conclusions: The number of medications veterans obtained from VA decreased after the copayment increase. There were relatively larger impacts on veterans with higher medication use and on lower-cost and over-the-counter medications.