Wednesday, February 21, 2007

'Tis a Gift to be Simple

I am printing this story from today's Boston Herald in its entirety. [As above, I have revised this posting to include excerpts, not the whole article.] My quote is accurate. I assume the others are, too. Hey, this is the only way I could get MGH on the record on this blog!

More seriously, a state-sponsored website could be set up for a few thousand dollars. In fact, I will donate the time of our Chief Information Officer to design the site. Hospitals could voluntarily post their data on three or four categories of infections (e.g., ventilator-associated pneumonia, ICU central line infections) along with any explanation they would like. The public could then watch each hospital's progress month to month and year to year.

This is not a game to compare hospitals one to the other: It is a crusade to see how each hospital improves its own processes. So, Valerie, you don't have to have a standard across all hospitals. Sure, that would be an added bonus, but if you wait for that, you will wait for a long, long time. And, Nancy, the internet obviates the need to have a one-size-fits-all standard.

Don't you have enough faith in the public to let them see what they will actually experience in our hospitals?

State eyes hospital infection reports
By Jessica Fargen, Boston Herald Health & Medical Reporter
Wednesday, February 21, 2007 - Updated: 04:01 AM EST

Patients may soon be able to shop for the safest hospitals thanks to a new $1 million public health plan that will make rates of deadly infections at Bay State medical centers readily available to the public for the first time.

The Department of Public Health team, which has enlisted 50 experts and surveyed 73 hospitals so far, expects to make recommendations in June on how to reduce life-threatening in-hospital infections and put in a place a plan to make the rates public, officials said yesterday.


Paul Levy, president of Beth Israel Deaconess Medical Center, created a big stir recently when he posted the hospital’s infection rates on his blog and encouraged other hospitals to follow suit without a complicated state mandate.

“Wouldn’t it be easier to try it out voluntarily - see how it goes?” he told the Herald. “My point is these numbers are available in real time. We all keep track of it. All the state has to do is set up a Web site and let us enter our data.”


But public health officials are taking a more measured approach, hiring experts, doing research and surveying hospitals.

“Just the nature of the patients, the case mix of patients means that there is not a one-size-fits-all solution to the problem,” said Nancy Ridley, director of the Betsy Lehman Center, which is leading the project with the DPH.

Massachusetts General Hospital spokeswoman Valerie Wencis echoed that concern, saying the hospital won’t post its rates until it’s mandated.

“You have to have a standard across all the hospitals,” she said. “That’s something that needs to be taken into consideration before rates would be put online or made public.”


Anonymous said...

Regarding “You have to have a standard across all the hospitals”,

AHRQ indicator PSI 7 (Selected infections due to medical care) is certainly a standard.

So are we ready to move forward yet, or is there yet another underlying reason not to report infections?

Labor Nurse, CNM said...

Good to see that you are lighting the fire...I do hope that this becomes mandatory. I think that it is important that consumers know how well their hospital is performing. Don't most people do research when buying a car? The same should be done when someone is seeking healthcare.

Anonymous said...

I was also taken by the statement “You have to have a standard across all the hospitals”

Do not hospitals already have standards, or does she mean a normalized scale for reporting these rates?

Is there a scale that would show the data without any bias?

I should think that these data would be based on morbidity and mortality and therefore a measurement of overall "quality" of care.

Any hospital that will wait for reporting like this to be mandated perhaps suggests they're hiding some awful numbers.

Anonymous said...

She means a scale that would take into account the severity of the illness of the patient and modify data on clinical outcomes based on the underlying risk facing the patient.

Steve said...

Great leaders wouldn't wait to be told what to do.

The PSI 7 that the previous commenter brings up is already risk adjusted. Waiting for perfect comparability depends on unknowables. In the meantime costs continue to march upwards and outcomes stagnate.

PSI 7, and all the other PSI indicators, are already available to the public. MGH's rate per 1000 is 3.8 and BI's is 3.2 from 2005.

The response? I'll wait till I'm told what to do.

It seams while MGH was waiting, the train already left the station.

Anonymous said...

Good point, Steve. But let's not pick on MGH just because they chose to be quoted in the Herald. (And let's not forget that MGH deserves credit for a stellar record of medical advances and clinical care over many decades.) To your point, Steve, ALL Boston hospitals have current data about clinical outcomes, but they choose not to show them to the public. They argue that there are no clear standards for comparison, a point belied (although 2 years after the fact) by the data on the public websites to which you refer.

I would really love it if one of them would post a comment here, even anonymously, as to why they are so reluctant on this point. Having seen thoughtful comments from many of you on many topics, it seems to me that this is a good (and safe) forum if they have a persuasive point to make.

Anonymous said...

Paul, we are following your posts and the comments you are receiving on hospital infections with great interest. May I refer you and your readers to the blog for the Robert Wood Johnson Foundation's Pioneer grantmaking portfolio, where we have asked for ideas on what RWJF/Pioneer could do to drive infections rates to zero? Public reporting is a start. What do you suggest?
Rosemary Gibson
The Robert Wood Johnson Foundation

Anonymous said...

I am perplexed by the quote, “Just the nature of the patients, the case mix of patients means that there is not a one-size-fits-all solution to the problem.”

The issue at hand is the ability of hospitals to reduce hospital-acquired infections. Why does patient mix matter ? Surely hospitals understand that we patients expect that the most vulnerable patients will be most closely monitored and protected.

This is indeed a one-size fits all issue. That one size is the level of commitment to the individual patient. If a hospital lacks the competence to handle complex patients, perhaps that hospital should transfer its patients to a more reliable facility.

The other size issue is the enormity of the hubris of state officials who want to spend millions of dollars in order to expand its bureaucracy rather than use existing data to at least start this vital discussion.