Wilson & Schuneman examine the evidence forming the basis for performance measures for community acquired pneumonia, and found it to be generally poor. Did the performance measures hold water? Pneumovax: weak yes (extremely low absolute effect). Blood cultures: too weak to say. Smoking cessation counseling: no. Antibiotics in 6 hours: very weak yes. Guideline-compliant antibiotics: strong yes (moderate evidence, large effect). Flu vax: strong yes (ditto). Authors suggest that the forceful mandates (with reimbursements at stake) accompanying some performance measures may be out of reasonable proportion to the evidence supporting them. AJRCCM 2011;183:1454-1462.
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