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Editorials represent the opinions EDITORIAL of the authors and JAMA and not those of the American Medical Association. Measuring Physicians’ Quality and Performance Adrift on Lake Wobegon ens of entities—so many of each that hospital leaders com- Donald M. Berwick, MD, MPP plain bitterly of the burden. But what about physicians? No doubt physicians vary in N GARRISON KEILLOR’S MYTHICAL HOMETOWN,LAKE WOBE- their clinical skills and outcomes. This is especially inter- gon, all the women are strong, all the men are good- esting now because physicians traditionally have been looking, and all the children are above average. That is, thought to hold the keys to the health care treasury, that is, Iof course, impossible, at least when it comes to the chil- the physician’s pen (or lately, keyboard), some argue, is at dren. In any given population for any defined characteristic the root of health care profligacy and could be the stron- “everyone above average” is, statistically, nonsense. gest lever to control health care costs wisely. Of course, the same is true of health care. Performance The reasons for comparative measurement of perfor- on anything called “good” about the care (such as reliabil- mance in health care are many
JAMA – American Medical Association
Published: Dec 9, 2009
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