The major disadvantage of process measures is that simply doing
the right thing does not ensure the best outcomes for patients.
While some process measures possess stronger causal links with
outcomes, such as immunizations, others such as measuring a
haemoglobin A1c do not. That a physician regularly monitors
HbA1c, for example, does not guarantee that he or she will make the
necessary changes in management. Furthermore, although process
measures are less susceptible to the difficulties of attribution, complexity
and case mix, these factors still have an adverse influence