Saturday, November 13, 2010

Moneyball and health care quality statistics - Part 2 of 2

The Society of Thoracic Surgeons recently allowed Consumer Reports to use its national database of information about heart bypass surgeries to rate surgical groups on patient survival rates, surgical complications, and medication management. But this ranking, too, has its limitations: While about 90 percent of the approximately 1,100 cardiac surgical groups in the U.S. participate in the society's database, just 22 percent of these groups opted to include themselves in the Consumer Reports rankings. That's because they didn't want their performance data to become public. And none would allow individual surgeons to be named.

Many health insurers have begun sending confidential "report cards" to family doctors that give them feedback on their performance in managing chronic conditions such as heart failure and diabetes. These evaluations, too, have been criticized for ignoring differences in patient populations; younger patients with high-paying jobs, for example, are less likely to stop taking medications for financial reasons than older patients on fixed incomes. So a doctor with a poorer patient population might get poorer grades than one with a richer population. Still, the evaluations might be helpful in comparing two doctors who practice in the same neighborhood, if practices eventually make this information public to prospective and current patients.

In the next few years, more information should become available on the quality of care provided to patients. The government is working to compile national numbers on hospital complication rates, which would add to patient safety data already being collected such as how often incisions reopen after surgery. The new data that will soon be offered on the Hospital Compare tool will, in my opinion, be a game changer. First and foremost, it will include information on infection rates. Nearly 90,000 U.S. patients die every year from hospital-acquired infections, and about a third of those deaths are due to preventable bloodstream infections caused by the insertion of a catheter, according to the Centers for Disease Control and Prevention.

It would be nice to know how often the hospital you pick for surgery takes precautions proven to prevent these infections, like covering patients with sterile drapes and swabbing their skin with an antiseptic before a catheter is inserted and making sure doctors who do the insertion wash their hands and wear a sterile mask, hat, gown and gloves. Hospital Compare will also provide data on surgical mistakes due to foreign objects left in the body; severe pressure ulcers from not turning bed-ridden patients, falls and other accidents that occur in the hospital; blood transfusions with the wrong blood type; and signs of diabetes mismanagement.

As more reliable statistics about the quality of care provided by doctors and hospitals become available, it's important to consider what factors matter most to you as a patient. For example, clean bathrooms are nice, but most people would place a higher value on surviving the hospitalization and not needing to return after being discharged. A heart surgeon's brusque bedside manner may not matter nearly as much to you as the percentage of her patients who develop postoperative infections. And family doctors who are willing to share their numbers—and work to improve them—are likely to go the extra mile to manage your chronic condition appropriately.


The above post (continued from a previous post) first appeared on my Healthcare Headaches blog at