tag:blogger.com,1999:blog-32053362.post3627591886649977866..comments2024-03-26T00:25:34.026-04:00Comments on Not Running a Hospital: Maryly proceeding off coursePaul Levyhttp://www.blogger.com/profile/17065446378970179507noreply@blogger.comBlogger7125tag:blogger.com,1999:blog-32053362.post-23767117226077786982011-03-24T16:12:19.869-04:002011-03-24T16:12:19.869-04:00To establish baseline for ACO contract rates, insu...To establish baseline for ACO contract rates, insurance companies have (1) risk scores, and will create (2) health scores of some sort (transparency anyone?) for individuals that bonuses to providers will be based upon. Providers will combine these with (3) clinical and patient participation scores to map progress (albeit in a limited way initially) to receive ACO benefits. From a patient's point of view, (4) quality of life or functional capacity scores might be most salient. Other research is attempting to get at individual health through an (5) 'allostatic load' measure, and there are other global assessments that could clearly be in demand. Where do different global measures intersect, and what delivery quality measures predict the greatest change?<br /><br />What if we ask the patient what they want when they come in the door and ask them if they got it on the way out?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-82606711631404761452011-03-24T14:52:21.390-04:002011-03-24T14:52:21.390-04:00Preventable harm would be a good start, but our pa...Preventable harm would be a good start, but our patients do not pay us solely to avoid harm. We need a measure that will assess the effectiveness of care as well as encouraging pro-active medicine.Garrett Beannoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-10435515274205470012011-03-22T23:59:52.409-04:002011-03-22T23:59:52.409-04:00How about preventable harm?How about preventable harm?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-70611981626856902152011-03-22T15:03:12.792-04:002011-03-22T15:03:12.792-04:00"It would be much better if the medical profe..."It would be much better if the medical profession demonstrated that it is capable of self-regulating in a way that persuasively exhibited a commitment to quality and safety and to patient involvement in the design and delivery of care."<br /><br />Well that is the crux of the issue, isn't it? The healthcare profession has not shown that it is capable of self-regulating. The all too often mantras of "my patients are sicker" or "the data are wrong" prevent any forward progress. The inability to develop a single meaningful metric that accurately and fairly captures quality will continue to prevent such progress. It may just be an impossible task. Every provider/researcher/agency/specialty group is quick to develop metrics in their niche area, but having dozens (let along hundreds) of metrics will continue to plague our ability to succintly measure quality.<br /><br />What if we could only define and use 1 metric to measure healthcare quality? What would that measure be? Maybe if we get everyone to focus in on answering that question and someday attain some semblance of consensus, we'll make actual forward progress.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-4284032929174944982011-03-22T11:55:44.269-04:002011-03-22T11:55:44.269-04:00Given the modest and siloed improvements made by m...Given the modest and siloed improvements made by medicine in self-regulation, these CMS style solution sets should be expected. Until ambitious QI becomes central and explicit to business strategy, there will be bean counting by external stakeholders, and the time and energy drain required to manage and respond. It also tends to relegate quality to specialists rather than explicitly the role of all. It is the tradeoff of teaching to the test, but failing at innovation.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-54269299853994684212011-03-22T07:55:49.481-04:002011-03-22T07:55:49.481-04:00I don't even think they will be able to focus ...I don't even think they will be able to focus on the 49. There are just too many items. To use an systems analogy, this is an approach that focuses way too much on the noise and not enough on the signal.Paul Levyhttps://www.blogger.com/profile/17065446378970179507noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-4322319253054600772011-03-22T07:53:38.447-04:002011-03-22T07:53:38.447-04:00Although Dr. Pronovost's comment about accurac...Although Dr. Pronovost's comment about accuracy of metrics is important, it is dwarfed by your point that it is 'unlikely to stimulate a sensible approach to process improvement'. Hospitals will inevitably focus on those 49 metrics instead of conceiving of a transformative, system-wide revision of their work - as laid out in Charles Kenney's book "Transforming Health Care."<br /><br />nonlocalAnonymousnoreply@blogger.com