An addendum: ‘Quality’ Often Flawed

Civitas, 17 April 2009

Just to support the point being made on this blog yesterday, today the British Medical Journal runs this in their editorial:

‘One problem with implementing evidence based medicine is, of course, that the evidence keeps changing. An important recent example is the mounting evidence that ever tighter glucose control in people with type 2 diabetes may actually be harmful. As Richard Lehman and Harlan Krumholz point out in their editorial (doi:10.1136/bmj.b800), the evidence that tighter control might not be better was emerging just as the targets for the 2009 quality and outcomes framework (QOF) were being re-negotiated. The framework sets evidence based clinical targets for British general practices to reach (and pays them for doing so), and it has helped improve the implementation of evidence based interventions. But the 2009 version now includes a tighter target for glycated haemoglobin—just as that looks to be the wrong thing to be doing.’

Oh dear.