Quality patient care not met by blanket screenings, warns UCSF/SFVAMC physician

Even as America's medical centers are being urged to use mathematical measures to describe quality care, a UCSF/San Francisco Veterans Affairs Medical Center physician is warning against the "pitfalls" of confusing such measurement with actual quality, in an opinion piece appearing in the May 26 issue of Journal of the American Medical Association.

In the article, Louise Walter, MD, UCSF assistant professor of medicine in the geriatrics division at the SFVAMC, acknowledges the importance of measuring the quality of medical care, but suggests that the current methodology for such measurement needs to be reexamined.

Walter based her comments on results of a study she and three UCSF/VAMC colleagues conducted of the medical records of the 229 patients selected in 2002 by national VA auditors to measure colorectal cancer screening at the San Francisco VA Medical Center. The study was conducted after clinicians at the San Francisco facility had been told that the center's screening rate of 58 percent in 2002 failed to meet the national VA target rate of 65 percent. Walter and her colleagues decided to conduct their own audit of the national VA' s audit of colorectal cancer screening at their facility to determine if there was a quality of care problem.

In their study of the records, the researchers found that many of the patients selected for audit by the national VA were elderly with severe illnesses, making the physical risks and other negative aspects of colorectal cancer screening outweigh the benefits. For example, she said, the dire health of patients with metastatic prostate cancer and end-stage renal failure increases the risks of colorectal cancer screening, which include perforation of the colon and cardiac complications. In her view, the decision by the SFVAMC physicians not to screen such patients represented good quality care, even though the decision was counted as poor quality care by the screening measure. In addition, she w

Contact: Joan Aragone
University of California - San Francisco

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