Correspondence  |   August 2016
In Reply
Author Notes
  • Division of General Surgery, University of Toronto, Toronto, Ontario, Canada (E.W.). elliot.wakeam@utoronto.ca
  • James C. Eisenach, M.D., served as Editor-in-Chief for this exchange.
    James C. Eisenach, M.D., served as Editor-in-Chief for this exchange.×
  • (Accepted for publication March 30, 2016.)
    (Accepted for publication March 30, 2016.)×
Article Information
Correspondence
Correspondence   |   August 2016
In Reply
Anesthesiology 8 2016, Vol.125, 423. doi:10.1097/ALN.0000000000001179
Anesthesiology 8 2016, Vol.125, 423. doi:10.1097/ALN.0000000000001179
We appreciate the thoughtful attention that Dr. Hofer and colleagues have given our article describing the advantages and disadvantages of reliability, or “shrinkage” adjustment.1  Their title, “Current Quality Registries Lack the Accurate Data Needed to Perform Adequate Reliability Adjustments” may be accurate for the anesthesia data collections they mention but not for all surgical quality registries.
Dr. Hofer and colleagues’ message about the importance of measurement error cannot be understated. Measurement error, whether in administrative data or in registries, undermines both the validity and utility of quality measurement. When reliability adjustment is applied, unmeasured patient and case-mix factors leave “residual” variation that may be falsely attributed to hospitals or physicians rather than inadequate risk adjustment.2  With or without reliability adjustment, measurement error is critical when benchmarking quality across hospitals or physicians because federal mandates are linking payment to outcome-based performance measurement.
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