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In Reply: Dr Van Matre offers an example of measuring diabetes care using 5 elements for patients A, B, and C. Patient A receives all needed care; patient B receives almost all needed care; and patient C receives none of the 5 elements. If we wish to focus on comparing patient B with patient C, then as Van Matre correctly states the particular all-or-none measure we used as an illustration in our article would not be helpful. An all-or-none measure with different elements (including, for example, the availability of access to affordable care) would be more suitable. The focus in our illustrative example of the all-or-none approach was to highlight the differences in care between patients A and B. More generally, as is true of all metrics, any specific all-or-none measure will be useful for some purposes and not for others.

Van Matre also cites as a problem the possibility . . . [Full Text of this Article]

Thomas W. Nolan, PhD; Donald M. Berwick, MD, MPP
dberwick1@ihi.org
Institute for Healthcare Improvement
Cambridge, Mass

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