Rocco Friebel and Adam Steventon wrote a paper entitled The multiple aims of pay-for-performance and the risk of unintended consequences, in the BMJ Quality journal. It’s unnerving when the measurement idiots start a trend of making sense.

Thus, advocates claim, readmissions impose a burden on patients and the healthcare system alike, while being amenable to certain improvements in service delivery. However, the relationship between readmissions and quality of care is not straightforward, and there are confounding factors, such as regional variations in the propensity of hospitals to admit patients.
Almost two-thirds of readmissions following a hospitalisation for heart failure are for some other diagnosis (64.8%), and figures for acute myocardial infarction and pneumonia are even higher, at 90% and 78%, respectively. However, a narrow focus on the acute illness that precipitated the hospitalisation might understate the significance of the allostatic and physiological stress that patients experience while in hospital.

In summary, stupidity is its own punishment. Applying simple rules to complex systems drives them to fail.  Quality is not a thug with a hammer.  It involves perceiving the facts of the situation.

It sounds like the anti-stupidity movement might take root, after all.  Quality is different than hiring thugs with clubs to beat the Bad Guys.  But doctors know that.

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