Author Interviews, JAMA, Outcomes & Safety / 10.08.2015 Interview with: Erika Newton MD, MPH Department of Emergency Medicine Stony Brook University Medical Center Stony Brook, NY and Brenda Sirovich MD, MS Staff Physician Co-Director Outcomes Group VA Medical Center White River Junction, VT Associate Professor of Medicine and of Community and Family Medicine Geisel School of Medicine at Dartmouth, and The Dartmouth Institute for Health Policy and Clinical Practice Division of Trauma Surgery, Department of Surgery Stony Brook University Medical Center Stony Brook, New York Medical Research: What is the background for this study? Response: Clinical performance measures – quality indicators used to evaluate and motivate health care providers' performance – play a central role right now in efforts to improve quality in U.S. health care. But their potential to influence care on a wide scale has some worried about unintended effects. In particular, there’s been growing concern that if performance measures focus disproportionately on underuse of care – that is, measuring whether enough care is being provided – they risk leading to unexpected consequences.   Specifically, if incentives tend to reward clinicians for doing more without attention to whether they do too much – this could inadvertently contribute to the problem of excessive care, or overuse. Medical Research: What are the main findings? Response: We thought it was important to look at what that balance is – between measures of underuse and measures of overuse – in outpatient practice.   We looked at 16 major national collections of performance measures and essentially counted measures targeting underuse (‘Did the clinician do enough?’) versus overuse (‘Did the clinician do too much?’). We found that over 90 percent of 521 outpatient measures targeted underuse, while a mere 7 percent of outpatient measures addressed overuse – in fact nearly half of the collections contained no overuse measures at all. (more…)