Intended for healthcare professionals


Endorsing performance measures is a matter of trust

BMJ 2018; 360 doi: (Published 23 February 2018) Cite this as: BMJ 2018;360:k703

This article has a correction. Please see:

  1. Dharmvir S Jaswal, staff physician,
  2. Charles Natanson, senior investigator,
  3. Peter Q Eichacker, senior investigator
  1. Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
  1. Correspondence to PQ Eichacker peichacker{at}

Healthcare agencies should ensure that performance measures for accreditation or reimbursement are supported by sound scientific evidence and safeguarded from potential commercial influences, argue Peter Eichacker and colleagues

Key messages

  • The US National Quality Forum endorses performance measures that the Centers for Medicare and Medicaid Services can then adopt nationally

  • The forum’s endorsement of a bundle of performance measures for managing sepsis, including the need for central venous pressure and blood oxygen saturation measures, failed to adhere to the agency’s own standards regarding the soundness of supporting scientific evidence and freedom from potential commercial influences

  • Unless government can ensure that its endorsements adhere to these standards, trust in the performance measures it endorses will be undermined

  • Commercial representatives should have no role in endorsing performance measures

Using evidence based performance measures to guide patient treatment is advocated to improve outcomes and decrease costs.1 The US Centers for Medicare and Medicaid Services uses performance measures to regulate US healthcare by withholding reimbursement and accreditation from non-compliant providers.234 With such compelling incentives, the performance measures essentially become healthcare mandates.

The National Quality Forum evaluates and endorses performance measures for the Centers for Medicare and Medicaid Services, ensuring that they are supported by strong, unbiased, scientific evidence.5 The NHS’s Quality and Outcome Framework has a similar role.67

SEP-1 is a performance measure for managing patients with sepsis that was endorsed by the forum and adopted by the Centers for Medicare and Medicaid Services while controversial interventions were still undergoing clinical testing. Even after this testing showed lack of efficacy, the interventions were not removed. Furthermore, a trade organisation with direct ties to a manufacturer standing to benefit from SEP-1 took part in the endorsement. Without rigorous, independent scientific review protected from potential industry influence, endorsements like that of …

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