The Unintended, Negative Consequences of the Door-to-Antibiotic Measure for Pneumonia
Authors: Robert M. Wachter
Journal: Annals of Internal Medicine (2009)

Letters3 February 2009The Unintended, Negative Consequences of the Door-to-Antibiotic Measure for PneumoniaRobert M. Wachter, MD, Christopher Fee, MD, and Scott A. Flanders, MDRobert M. Wachter, MDFrom University of California, San Francisco, San Francisco, CA 94143, and University of Michigan, Ann Arbor, MI 48109.Search for more papers by this author, Christopher Fee, MDFrom University of California, San Francisco, San Francisco, CA 94143, and University of Michigan, Ann Arbor, MI 48109.Search for more papers by this author, and Scott A. Flanders, MDFrom University of California, San Francisco, San Francisco, CA 94143, and University of Michigan, Ann Arbor, MI 48109.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-150-3-200902030-00017 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We appreciate the letters, which endorse our main premise while adding new data and insights. Although we agree with most of the authors' points, we worry that the experience of a flawed measure, such as door-to-antibiotics for pneumonia, will lead some to throw out the baby (quality measurement and transparency) with the bathwater (the bad measure).For example, Dr. Dean argues that the imposition of a national standard for pneumonia care undermined his organization's homegrown pneumonia strategy. We agree that national guidelines should provide enough flexibility to allow for individual institutional choice based on local factors, such as ...References1. Hougaard J. Developing evidence-based interdisciplinary care standards and implications for improving patient safety. Int J Med Inform. 2004;73:615-24. [PMID: 15246042] CrossrefMedlineGoogle Scholar2. McGlynn EA, Asch SM, Adams J, Keesey J, Hicks J, DeCristofaro A, et al. The quality of health care delivered to adults in the United States. N Engl J Med. 2003;348:2635-45. [PMID: 12826639] CrossrefMedlineGoogle Scholar3. Fisher ES, Wennberg DE, Stukel TA, Gottlieb DJ, Lucas FL, Pinder EL. The implications of regional variations in Medicare spending. Part 1: the content, quality, and accessibility of care. Ann Intern Med. 2003;138:273-87. [PMID: 12585825] LinkGoogle Scholar4. Smith Moore T, Francis MD, Corrigan JM. Health care quality in the 21st century. Clin Exp Rheumatol. 2007;25:3-5. [PMID: 18021499] MedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University of California, San Francisco, San Francisco, CA 94143, and University of Michigan, Ann Arbor, MI 48109.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoThe Implications of Regional Variations in Medicare Spending. Part 1: The Content, Quality, and Accessibility of Care Elliott S. Fisher , David E. Wennberg , Thrse A. Stukel , Daniel J. Gottlieb , F. L. Lucas , and Étoile L. Pinder Public Reporting of Antibiotic Timing in Patients with Pneumonia: Lessons from a Flawed Performance Measure Robert M. Wachter , Scott A. Flanders , Christopher Fee , and Peter J. Pronovost The Unintended, Negative Consequences of the Door-to-Antibiotic Measure for Pneumonia Nathan C. Dean The Unintended, Negative Consequences of the Door-to-Antibiotic Measure for Pneumonia Manfred Gogol The Unintended, Negative Consequences of the Door-to-Antibiotic Measure for Pneumonia Nadine Srouji Metrics 3 February 2009Volume 150, Issue 3Page: 220KeywordsAntibioticsConflicts of interestForecastingHealth careHealth information technologyInformation technologyPneumonia ePublished: 3 February 2009 Issue Published: 3 February 2009 CopyrightCopyright © 2009 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...