At the Intersection of Health, Health Care and Policy
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Health Affairs is published monthly by Project HOPE at 7500 Old Georgetown Road, Suite 600, Bethesda, MD 20814-6133. Copyright © by Project HOPE - The People-to-People Health Foundation. As provided by United States copyright law (Title 17, U.S. Code), no part of may be reproduced, displayed, or transmitted in any form or by any means, electronic or mechanical, including photocopying or by information storage or retrieval systems, without prior written permission from the Publisher. All rights reserved.
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Cite this article as: David O. Meltzer and Jeanette W. Chung Quality Indicators: The Authors Reply Health Affairs 33, no.4 (2014):723 doi: 10.1377/hlthaff.2014.0144
Letters There is a limit of 300 words for letters to the editor. Health Affairs reserves the right to edit all letters for clarity, length, and tone. Letters can be submitted by e-mail, [email protected], or the Health Affairs website, http:// www.healthaffairs.org.
10.1377/hlthaff.2014.0144
Quality Indicators: The Authors Reply We developed our approach (Jan 2014) to understand the value of quality indicator reporting. However, we agree with Thomas Kottke that our framework has other applications in prioritizing disease prevention and treatment interventions, including the example he provided.1 Kottke notes that a key element of our approach is to calculate the product of “the proportion of people in a population who are candidates for a particular intervention, the rate of events for the people who are candidates for the intervention, the impact of the intervention on the rate of events, and the proportion of candidates for the intervention who are currently not receiving it.” We agree in general, but it is useful to distinguish between two meanings of the word intervention. The first meaning refers to clinical interventions, or interventions that directly change the health of the people receiving them (an example is the administration of an antihypertensive medication). The second refers to policy or clinical practice interventions designed to change the pattern of use of clinical interventions (an example is the American Heart Association’s “Get
Downloaded from http://content.healthaffairs.org/ by Health Affairs on June 21, 2016 by HW Team
doi:
with the Guidelines” program).2 The distinction between the two meanings is useful because policy or clinical practice interventions (including quality indicator reporting) are variably effective, and their effectiveness may be important in selecting among them. With appropriate data, our framework is especially well suited to evaluating these interventions. In Kottke’s example, such interventions might be more promising in the inpatient setting, even if the potential benefits from maximal improvements in the ambulatory setting are greater. Empirical data on the efficacy of interventions is critical in answering this question. We also note that our framework incorporates costs, an issue not addressed by Kottke. David O. Meltzer University of Chicago CHICAGO , ILLINOIS Jeanette W. Chung Northwestern University CHICAGO , ILLINOIS NOTES 1 Kottke TE, Faith DA, Jordan CO, Pronk NP, Thomas RJ, Capewell S. The comparative effectiveness of heart disease prevention and treatment strategies. Am J Prev Med. 2009;36(1):82–88. 2 Smaha LA. The American Heart Association Get with the Guidelines program. Am Heart J. 2004;148(5 Suppl):S46–8.
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The online version of this article, along with updated information and services, is available at: http://content.healthaffairs.org/content/33/4/723.1
For Reprints, Links & Permissions : http://content.healthaffairs.org/1340_reprints.php Email Alertings : http://content.healthaffairs.org/subscriptions/etoc.dtl To Subscribe :
https://fulfillment.healthaffairs.org
Health Affairs is published monthly by Project HOPE at 7500 Old Georgetown Road, Suite 600, Bethesda, MD 20814-6133. Copyright © by Project HOPE - The People-to-People Health Foundation. As provided by United States copyright law (Title 17, U.S. Code), no part of may be reproduced, displayed, or transmitted in any form or by any means, electronic or mechanical, including photocopying or by information storage or retrieval systems, without prior written permission from the Publisher. All rights reserved.
Not for commercial use or unauthorized distribution
Downloaded from http://content.healthaffairs.org/ by Health Affairs on June 21, 2016 by HW Team
Cite this article as: David O. Meltzer and Jeanette W. Chung Quality Indicators: The Authors Reply Health Affairs 33, no.4 (2014):723 doi: 10.1377/hlthaff.2014.0144
Letters There is a limit of 300 words for letters to the editor. Health Affairs reserves the right to edit all letters for clarity, length, and tone. Letters can be submitted by e-mail, [email protected], or the Health Affairs website, http:// www.healthaffairs.org.
10.1377/hlthaff.2014.0144
Quality Indicators: The Authors Reply We developed our approach (Jan 2014) to understand the value of quality indicator reporting. However, we agree with Thomas Kottke that our framework has other applications in prioritizing disease prevention and treatment interventions, including the example he provided.1 Kottke notes that a key element of our approach is to calculate the product of “the proportion of people in a population who are candidates for a particular intervention, the rate of events for the people who are candidates for the intervention, the impact of the intervention on the rate of events, and the proportion of candidates for the intervention who are currently not receiving it.” We agree in general, but it is useful to distinguish between two meanings of the word intervention. The first meaning refers to clinical interventions, or interventions that directly change the health of the people receiving them (an example is the administration of an antihypertensive medication). The second refers to policy or clinical practice interventions designed to change the pattern of use of clinical interventions (an example is the American Heart Association’s “Get
Downloaded from http://content.healthaffairs.org/ by Health Affairs on June 21, 2016 by HW Team
doi:
with the Guidelines” program).2 The distinction between the two meanings is useful because policy or clinical practice interventions (including quality indicator reporting) are variably effective, and their effectiveness may be important in selecting among them. With appropriate data, our framework is especially well suited to evaluating these interventions. In Kottke’s example, such interventions might be more promising in the inpatient setting, even if the potential benefits from maximal improvements in the ambulatory setting are greater. Empirical data on the efficacy of interventions is critical in answering this question. We also note that our framework incorporates costs, an issue not addressed by Kottke. David O. Meltzer University of Chicago CHICAGO , ILLINOIS Jeanette W. Chung Northwestern University CHICAGO , ILLINOIS NOTES 1 Kottke TE, Faith DA, Jordan CO, Pronk NP, Thomas RJ, Capewell S. The comparative effectiveness of heart disease prevention and treatment strategies. Am J Prev Med. 2009;36(1):82–88. 2 Smaha LA. The American Heart Association Get with the Guidelines program. Am Heart J. 2004;148(5 Suppl):S46–8.
April 2 014
33:4
H e a lt h A f fai r s
723
