I’ve complained before about the uselessness of traditional industrial QI/Metrics in primary care. There is now more proof in the literature.
The National Health and Nutrition Examination Survey (NHANES) is the annual comprehensive assessment of American health. They enroll about 10,000 people each study year and ask them a thousand questions, draw lots of blood, and so on. This is the data source where we get to hear each year that Americans keep getting fatter, for example.
A study in JAMA Internal Medicine collected NHANES data from 2005-2016. Remember, all across the country insurance companies, Medicare, and Medicaid were foisting a litany of measurements on all physicians. This timeframe crosses the eras of HEDIS, PCMH, ACOs, MIPS, and MACRA (and probably a few more alphabet soups I can’t remember at the moment). The researchers asked the basic question, how has diabetes control changed over this time frame?
Druummm roooollllll — NO difference. There was absolutely no change in the average A1c of the diabetic participants across the years. They collapsed the years into 3 blocks, and the A1cs were 7.3, 7.3, and 7.5. Nor were there differences in blood pressures, or cholesterol levels.
Why no change? Because family medicine is a well-connected agent in a complex adaptive system that interacts with many layers of systems, and it can’t be controlled from the top, which is exactly what HEDIS, PCMH, ACOs, MIPS, and MACRA tried to do.
Will the bureaucrats give up on their futile attempt to micromanage family medicine, thereby damaging its ability to adjust for local conditions, systems, and patient preferences? I’m not holding my breath.
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