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To the Editor: In their Commentary, Drs Nolan and Berwick¹ argue for an all-or-none performance assessment of quality. They cite the 2004 National Healthcare Quality Report² that found that only 32.1% of patients with diabetes had all 5 recommended interventions. That study looked at whether patients reported receiving a flu shot, retinal examination, and foot examination in the past year and had a glycohemoglobin and lipid measurement in the past 2 years. Other organizations, such as the Wisconsin Collaborative for Healthcare Quality, are also trying to measure quality by reporting all-or-none scores, such as whether a diabetic patient has had cholesterol screening or measurement of kidney function in the past 12 months.³ This may not be a fair measurement of quality in chronic disease management.

I am not aware of evidence that getting recommended tests done once yearly and not 1 day or week or month later makes a difference. . . . [Full Text of this Article]

Mark K. Chelmowski, MD
mchelm@ah.com
Department of Internal Medicine
Advanced Healthcare
Milwaukee, Wis

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