nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
See here for more discussion.

Friday, September 10, 2010

Being Your Own Health Care Decision-Maker: Using Online Quality Data

If you could see data on how well your hospital/doctor stacks up in quality terms, could you decipher it, or take the time to learn how?

The current issue of the New England Journal of Medicine (Sep 7) has an article about publishing cardiovascular surgery (CVS) results online for patients to review.  In principle, I'm all for transparency of quality measures in medicine. There are some limitations that have to be recognized, though.

This particular effort, while groundbreaking, included only 20% of the total number of cardiovascular surgery programs in the nation.  About 90% of the programs contribute their data to the quality database that's maintained by the Society of Thoracic Surgeons (STS). This means that only a fifth of the programs allowed their data to be published.  Furthermore, the programs that have allowed their data to be viewed publicly are those that are probably in pretty good shape (human nature being what it is, they probably see it as a positive advertisement for their program).  Of the 55 programs in the published data, 50 are in the highest category, earning three stars out of three.  Only five earned the lowest category rating, which is one star.

The list of the CVS quality measures are good ones. They look at infection rates, complication rates, readmissions, mortality, etc.   This is the (semi-readable) list of the quality measures:

All of these are pretty scary.  But if you need heart surgery, you're already in the hurt locker.  In addition to the star rating, patients can see actual performance data that generate the rating:  for instance, whether “patients have an 89% chance of avoiding all five of the major complications,” and the like.
What doesn't appear in the data are the characteristics of the patient population that underwent surgery at each institution (as far as I can tell).  A surgery program that tends to care for patients that are sicker will do less well than one that takes care of patients that are more healthy. Hospitals that have more elderly or socioeconomically disadvantaged patients would fall into the poorer results category. This is just a fact of life and shouldn’t be a ding on the program.

Another thing critics will point out: the data are not presented by surgeon, only by facility (or program).

Efforts like these can be picked to pieces and doctors sometimes are very nervous that their efforts will be mischaracterized, or their results erroneously reported. But this is a great step forward in giving patients the transparency they need to make health care decisions. And, as the authors of the article point out, there will be now be increased pressure on other programs to allow their data to be seen.

You can read the article at the New England Journal here.

A different question is whether the patient population has the ability to look at certain very specific and medically complex criteria and make a reasonable decision.  In my opinion, most people are capable of interpreting results such as these, but it's just going to take them time and effort. If they accept the authority that's given to them to make a reasonable decision, and put in the effort to learn how to judge what is good, and what is not so good, then they will retain control of their own medical care.  The alternatives are (1) to accept what you get, or (2) let Big Brother do it for you.

It remains to be seen whether patients are willing to make the effort.

Doc D

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