Performance measures – primum non nocere

New drugs require federal approval.  New devices require federal approval.  Before we try to help patients, we must show that we can help them and not hurt them.

So why should performance measures have a different standard?  Performance measure induce treatments.  Several studies have shown that overly aggressive performance measures have resulted in negative outcomes.

It likely does not matter if the performance measure is used for P4P or just in reporting.  The existence of a report influences our practice.

Thus, we should demand that any performance measure meet the same criteria as a new drug – it should both show benefit and a low rate of harm. 

We can state that few current performance measures can meet this standard.  Yet if we are using performance measures ostensibly because of evidence based medicine, then we should expect evidence that they positively influence patient outcomes.