Friday, December 10, 2010

Dr. Vollmer and team continue to tell all

Transparency of clinical outcomes has now become part of the culture at BIDMC, and that is nowhere as evident as in our outcomes for pancreatic resection surgery. These are difficult procedures, where surgical skill matters, but where use of a standardized plan of care (or clinical pathway) makes a large difference.

Our website contains a clear exposition of the results in our hospital. As noted by Doctor Charles Vollmer in our Department of Surgery,

"This summary reflects our initiative for total transparency of the real outcomes from our practice which are available to anyone through our institutional website. We believe this is a unique approach in our specialized field of pancreas surgery, and I would even contend it is rare to see anything like this for any general surgical domains around the country."

Credit for this approach also clearly goes to Dr. Mark Callery, chief of our general surgery division, and also a major practitioner in this particular field.

You can find the website here. The new numbers are about to be posted. Here is a sneak preview, showing the changes from 2007 through 2010.

Volume of Procedures: 82; 73; 86; 89
Mortality Rate: 1.2%; 0%; 3.5%; 1.1%
Length of Stay (Median): 7.5 days; 8 days; 8 days; 7 days
% of Patients Requiring Admission to an ICU: 8.5%; 12.3%; 17.4%; 11.2%
Blood Loss During Surgery (Median): 300ml; 300 ml; 275 ml; 200 ml
% of Patients Requiring Post-Op Blood Transfusions: 14.6%; 26%; 12.9%; 19.1%
Reoperation Rate (within 3 Months): 6.0%; 6.8%; 7%; 3.4%
Readmission to Hospital (within 90 days) Rate: 13.4%; 25%; 29%; 11.2%
Central Venous Line Infection Rate: 0%; 0%; 1.2%; 1.1%
% of Patients Receiving Immunizations Prior to Discharge (for Splenectomy): 100% (all years)

As I have said previously with regard to another topic, if we can post these rates for BIDMC, why can't people from other hospitals? Why can't the insurance companies post them? Where are the public health advocates on this topic? The data are collected regularly by all hospitals. We must get past a culture of blame and litigation and persuade people that transparency works: Real-time public disclosure of key indicators like this (not the untimely publication of "process" metrics) can be mutually instructive and can help provide an incentive to all of us to do better.

Some people have argued that transparency will lead to doctors trying to avoid the high risk cases. I know from personal knowledge of some of their patients that such is certainly not the case with Dr. Vollmer and his colleagues. Note, too, that they make no attempt to risk-adjust the metrics above. These are all-in figures.


Anonymous said...

Just for fun, I googled 'outcomes pancreatic resection' for Cleveland Clinic (renowned for its fancy-schmancy outcomes booklets sent to outside physicians); Mayo Clinic, and BIDMC. Results:

CC: one bar graph on pancreatic cancer citing "Progress toward Leapfrog objectives". ???

MC: nothing on outcomes, just an educational page on various types of pancreas surgery.

BIDMC: took me right to the website with the outcomes chart.

They should be coming to you to learn how to do this.


Ruth Nayko, RN, MBA, CPHQ, CPHRM said...

I am a member of the recently formed National Association for Healthcare Quality (NAHQ) Ethical Challenges in Healthcare Quality Task Team. We recently completed a member survey regarding ethical dilemmas that quality professionals face and are drafting a white paper which will include an analysis of the member survey. We plan to collaborate with other stakeholders in early 2011 to address these issues.

There are issues with intimidation of quality professionals who seek to address and remedy significant quality issues. Yes, we must get past a culture of blame and litigation and persuade people that transparency works.

Anonymous said...

Nice job!
What about patient satishfacton? The number above are easy to measure, it is however not always the easiest measurements that are the best.

Engineer on Medicare said...

"What about patient satisfaction? The numbers above are easy to measure, it is however not always the easiest measurements that are the best."

The best numbers are the ones that are objectively related to the well-being of the patient and can't be easily fudged. If I were contemplating that surgery the mortality rates would mean a lot more to me than a string of 99 to 100% patient satisfaction bars on a chart.

Barry Carol said...

Perhaps surgery cases are different but I’m a bit skeptical of patient satisfaction scores when it comes to doctors. Medical experts have told me in the past that many, if not most, patients judge doctors based on the three A’s – affability, availability and, last and LEAST, ability. Personally, I much prefer a doctor with excellent clinical and, hopefully, communication skills. I can tolerate a little arrogance if I have to. With respect to hospital stays, lots of people equate satisfaction with pleasant, capable and responsive nurses, nice surroundings and decent food. For surgeries, as Engineer notes, the objective outcome measures, risk adjusted if possible, should get the most weight in determining quality.