Thursday, September 23, 2004

Aren't we doing a Lousy Job?????
Poor Medical Treatment Kills Thousands in U.S., Says New Report on Health Care Quality
Requiring doctors and hospitals to report publicly on their performance and tying their pay to the results would dramatically reduce avoidable deaths and costs attributable to poor medical care, says a new report from an organization that works to improve health care quality.
Wild variations in medical care led to 79,000 avoidable deaths and $1.8 billion in additional medical costs last year, the private National Committee for Quality Assurance said in its annual report released Wednesday.
Well at least they aren't stating we actively kill people as the IOM did. The report, which may be found in PDF form here, uses indicators of preventative health measures (immunizations, cancer screenings) and some therapies (beta blockers) and reviews health plans compliance with those indicators. This is then extrapolated into statistics such as "avoidable deaths" (page 11) as well as "avoidable/non-fatal events" (page 12). To come up with these they took eight quality measures :Advising Smokers to Quit, Beta-Blocker Treatment After a Heart Attack, Breast Cancer Screening, Cervical Cancer Screening, Cholesterol Management - Control, Comprehensive Diabetes Care - HbA1c Control, Controlling High Blood Pressure and, Timeliness of Prenatal Care. Then :
Using the data above as a baseline and comparing it to the 90th percentile care offered by the best health plans, we can calculate the expected avoidable mortality and morbidity for a number of the nation's most common, costly and deadly diseases if everyone received care through one of the top plans.
So the study shows the expected mortality, which according to the summary is estimated to be between 42,000 and 79,000. The report provides no detail of how those figures were calculated. Certainly a range that large cannot reflect much reliability of the estimates. Anyway it is a far cry from "poor treatment kills thousands".
Another part of the report has to do with "pay for performance" using benchmarks such as this for indicators. So if you have the right percentage of your patients on beta blockers, control their cholesterol, and scold them enough about smoking you can buff your numbers and your paycheck will reflect that. Some programs already in place are described.
I wonder when they will start coming up with such detailed studies of surgical benchmarks? There are already some out there for such things as breast conservation versus mastectomy but certainly not as many as seen here.
Cross-posted at Galen's Log
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