Some quality is created more equal that others

Which of the following is backed by a robust level of literature demonstrating a consistently strong association between the intervention and an impact on morbidity and mortality? Is there a correlation between that impact and cost savings?

• · Restricting sodium among persons with hypertension
• · Influenza vaccination in persons with asthma
• · Foot examination in persons with diabetes
• · Weight measurement in heart failure

According to authors from the well-regarded Bridges to Excellence, Towers Perrin and the WDE the answer is none of the above and yes, their low impact means none reduce claims expense. You can read how they reached their conclusions here in the American Journal of Managed Care.

While much of their analysis is based on an unfamiliar rating point scale that simultaneously reconciles both clinical and economic value, it’s another good example of how a) all quality is not equal and b) many of assumptions about clinical and economic impact are not necessarily backed by the scientific literature. That doesn’t mean that a local market or consensus-based policy (absent an autonomous Health Fed) can’t choose one intervention over another based on other metrics. This is just another handy reminder of that reality.

Finally, it's an indication that purchasers, in their eternal quest for value, may demand that the disease management community focus on what they define as important.