You Deserve the Best Care – Philosophical Differences Between the Measurement Approaches

By | May 16, 2012

What passed for true knowledge and scientific inquiry in the Middle Ages should not satisfy us today.

Before we begin to examine the two main approaches to measuring medical quality in detail, it is instructive to look at the basic philosophical differences. The transactional approach is basically behavioristic and scholastic in its approach to the problem and in my opinion suffers from both of these characteristics, whereas the results based approach is scientific in the modern Baconian sense of the word. The transactional approach benefits from its behavioristic approach to the problem. Behavior is easy to define and easy to measure, but it is not exactly what we are interested in. This forces the transactional camp to arbitrarily define which behaviors lead to improved quality and which don’t. The list of quality determining behaviors is necessarily incomplete and no method of weighting and validating the results has yet been found. This means that designation of quality is really a measure of conformity, much in the way that medieval scholasticism judged the correctness of any proposition in terms of agreement with and citation of accepted authorities, regardless of whether it agreed with the real world or not. The results based approach suffers from the fact that it is necessarily retrospective and that it is best at measuring aggregate results of large groups and inadequate sample sizes and individual variation can invalidate the results with respect to any given practitioner. It is also difficult to establish the key factors that may make the quality of care delivered by group A superior to group B. Furthermore while behavior tends to be stable over time, there is also no guarantee that the practices, which produced superior results in one year, will produce superior results in future year.  At Schlesinger Pain Centers we believe that there has to be a simpler more humanistic way of establishing the value of what we do in the treatment of chronic pain.  But this will have to wait.  Tomorrow we will begin to examine some of the individual practical problems with each of the approaches.

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