tag:blogger.com,1999:blog-32053362.post2370075731148143869..comments2024-03-18T06:27:51.599-04:00Comments on Not Running a Hospital: Did I say unintended consequences?Paul Levyhttp://www.blogger.com/profile/17065446378970179507noreply@blogger.comBlogger7125tag:blogger.com,1999:blog-32053362.post-11775407394208092322011-10-22T05:59:47.331-04:002011-10-22T05:59:47.331-04:00Well put!Well put!Paul Levyhttps://www.blogger.com/profile/17065446378970179507noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-40065818324189065142011-10-21T22:00:06.761-04:002011-10-21T22:00:06.761-04:00The problem with readmission rates is not the prob...The problem with readmission rates is not the problem with readmission NOR rates.<br /><br />We will keep spinning these wheels until we understand that the systems that we have been trying to fix are microcosms of a larger ecology of care designed around providers, not around health. It is like fixing a flat tire on a car that can't climb the cliff in any case. <br /><br />Readmissions are determined by everything that happened before a patient - a person - steps or is rolled into the door. It is the years of battered somatic capital - poor maternal health, elevated glucose, blood pressure, weakened immune system, high cortisol, obesity, malnutrition, stressed mental condition, neglected social crucibles. And everything about that environment that determines health when they are rolled out again with discharge 'education' in hand, family members whose jobs are threatened when they need to take more days off, and every risk factor patients left waiting at their door. <br /><br />What medical school trains a physician - especially a surgeon - to ask: tell me about your life? What supports do you have? How close is a grocery store? How many fresh vegetables have you had this week? Do you have someone who can read the prescription bottles for you? Here's one. Can you tell me what it says?<br /><br />We are trying to solve human infrastructural problems with the wrong tools. All of science bends to the answer, and it is not confined to the right protocol. It should not be lost to anyone that Anish Jha is a public health scientist. <br /><br />There is so much that community hospitals can do - in fact, they do so much around care that is abandoned elsewhere. But we have no triage system to know which cases to send to the most expensive hospitals, and how many can be done locally, because we have no health infrastructure. <br /><br />Paul, isn't this like repairing a valve when no one is thinking about water?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-29749184309046040902011-10-21T12:28:06.930-04:002011-10-21T12:28:06.930-04:00Having read both posts (but admittedly not the bac...Having read both posts (but admittedly not the background articles) the problem does not seem to be with readmission rates as an indicator per se but the lack of a comparator. (I know what I am about to propose has ong run problems due to unintended consequences and peverse long-run incentives but I think it is worth mentioning for short run demonstration that change is possible.)<br /><br />Why not compare readmission rates within an institution over time? e.g. the five-year average over 2013-2018 vs the five year average of 2006-2011? If financial incentives are frought with problems, make it a prize. $1 million and bragging rights for the Top 10 in 10 different categories.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-1340970147287521112011-10-21T08:02:52.126-04:002011-10-21T08:02:52.126-04:00Stay tuned...Stay tuned...Paul Levyhttps://www.blogger.com/profile/17065446378970179507noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-14291277569571580782011-10-21T07:57:28.374-04:002011-10-21T07:57:28.374-04:00> more compelling ways to get improvement
Well...> more compelling ways to get improvement<br /><br />Well let's hear 'em! :-) (If I missed them in the original post, I apologize.)e-Patient Davehttps://www.blogger.com/profile/16381434866099596466noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-33665976876508974942011-10-21T07:46:17.409-04:002011-10-21T07:46:17.409-04:00No flip-flop at all, Dave. I have always been war...No flip-flop at all, Dave. I have always been wary of targeted financial penalties and incentives in the health care arena. I think there are more compelling ways to get improvement.Paul Levyhttps://www.blogger.com/profile/17065446378970179507noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-82041381652538471342011-10-21T07:28:00.408-04:002011-10-21T07:28:00.408-04:00So, Paul, if I recall correctly, you've always...So, Paul, if I recall correctly, you've always been the one to say "I know there will be things to be worked out, but there is a greater good to be pursued." In this case I can almost hear you: "Even aside from the obvious cost issues of redundant care caused by failed discharges, there is the human cost to the patient and the family of the worry, cost, lost productivity while caregiving, and returning to the risk of hospital-acquired infections, not to mention the just plain uncomfortable and unhealthy experience of trying to get a good night's sleep in a hospital while you're sick. Can't we agree that it's important to get started, and be vigilant about unintended consequences so we can fix them?"<br /><br />What the heck is the flip-flop here?e-Patient Davehttps://www.blogger.com/profile/16381434866099596466noreply@blogger.com