Sunday, April 08, 2012

Opaque, not transparent

Where does this fall on the spectrum from transparent to opaque?

A doctor friend in a Midwest hospital, who devotes his life to quality and safety improvement, writes:

I am getting my ACL repaired a week from Monday.

I have been unable to get my hands on any data regarding which surgeon has fewest complications, let alone best outcomes – and I have some knowledge of the system.

Heck, I don’t even know our institutional data for outcomes/complications for ACL repairs. 

To make the point further, he referred me to this recent article on Forbes.  Here's the lede: 

Hospitals across the country are using near-total discretion in the way they disclose infections that occur as a result of surgeries, cause over 8,000 deaths annually in the U.S., and cost an additional $10 billion per year to the healthcare system, a new study underscoring the need for public reporting standards has found.

The report, published in the Journal for Healthcare Quality, and authored by researchers at Johns Hopkins University School of Medicine, shows that only 21 states currently have legislation that requires monitoring and public reporting for surgical site infections. Of those, only eight states actually make the data publicly available, and only a total of 10 procedures – out of 250 possible types of surgeries - get reported.


The Medical Contrarian said...

It is not at all surprising that this outcomes data is not widely available. We simply do not embed data collection in what we do. I had an Achilles tendon repair a few years ago. Once I got past the acute phase post surgery, there has been essentially no effort to find out how I have fared at this point.

I have come to realize that health care (particularly ambulatory)is like the retail sales industry at the turn of the last century, after the deployment of the cash register. We know how many transactions we have had and how much money is in the till. Any data beyond that is not collected in any systematic or consistent way. Without consistent and structured data collection using standardized tools, reporting of these outcomes is a pipe dream.

Anonymous said...

I agree with Contrarian MD, but our profession has already shown that we can and will quibble endlessly with how data is collected so that implementation of standardized collection is indefinitely delayed. I have come to the conclusion that it's time to get SOMETHING out there, however flawed, to serve as a motivator, and then let several iterations improve the quality of the data. Despite all the vitriol aimed at CMS, it sounds like they have reached a similar conclusion.

nonlocal MD

e-Patient Dave said...

Where do we go, to start legislation about this?

dsblanchard said...

Your check box post made me think of my situation. Nurses are being terminated from the hospital system for "falsification of documentation". Many times the "falsification" mischecking of boxes, mistiming of checked boxes and simply forgetting to check boxes. In the termination policy of the hospital, "falsification of documentation" is immediate dismissal. I live in a no-fault state where anyone can be fired at any time without reason. Lately a lot of 60ish nurses are getting terminated for this "reason". These nurses are highly paid, close to retirement and beginning to take sick days. "Falsification of documentation" is an easy way to show them the door.