Tuesday, July 2, 2013
Direct Family Medicine: Personalized Quality Measures
The quality of medical care or health care is an important, but confusing, concept. What is quality?
Currently, one might say that quality in health care is a number that measures something of importance to non-patients. Examples are the percentage of a physician's patients with diabetes who are taking a statin drug or the percentage of persons with asthma who have had an annual pulmonary function test.
Did patients devise these quality measures? No.
What if patients did develop "quality" measures? What do we (yes, I'm a patient,too.) believe to be important?
How about the ability to meet personal goals such as learning to play "Cripple Creek" on the banjo before the family reunion? Or being able to lift my grandson and carry him for 50 feet without my right knee giving out by Thanksgiving? Or feeling free to express my opinions about finances in a church committee meeting or an organized medicine committee meeting?
How about honoring my aunts in my personal blog before Thanksgiving? Or getting increased exercise stamina and losing 18 pounds before September 10th? Yes, these are reasonable goals to work on with my Family Physician. Yes, they should be entered into the medical record. Yes, the measuring authorities should give me and my physician credit for achieving these quality goals.
Does the envisioned PCMH give credit for achievement of these personal quality goals? Will the NCQA? Is the AHRQ paying someone to study this approach to quality?
If my Family Physician shows me respect and protects me from unnecessary medical procedures, should he get credit for improving quality? I hope so.
If my Family Physician allows me to manifest human eccentricities of lifestyle, such as marching in a political protest, might he get "quality points"? I hope so.
OK, I wonder about promoting "Wholeness". If my physician reaffirms my worth as a human being, might he get quality credit? I hope so.
In a Direct Family Medicine Practice (Direct Primary Care business model), a patient and physician can work together to devise quality initiatives that reaffirm, refresh and realign the humanity of both patient and physician. Personalized quality goals are achievable. Freedom is refreshing.
What do you think?