Measures for Healthcare?
Stephen Schoenbaum, et. al. comment on AHRQ’s healthcare Quality Report 2006. The good news is that 26 of 40 core measures improved, representing about 3% improvement per year. The authors were disappointed in the slight improvement, and I agree. If this were a mutual fund, I’d sell. They also cite the occasional wide variation among states in rates of improvement. The implicit question is, “Why didn’t everyone improve?” The real question is, “Why did anyone?”
Many, if not most of the AHRQ measures have nothing to do with healthcare, so any changes are not related to the quality of any healthcare provided. For example, whether or not a woman goes to an obstetrician in her first trimester has nothing to do with the actual care she might receive if she actually went. Factors such as insurance, income, education, location, transportation, etc. are more important influences on this metric. Also, the authors wring their hands over the increase in suicide rates, but it’s not clear from the NHQR that those who committed suicide ever received any mental health care.
The lack of improvement in other factors is hardly surprising. Practitioners and institutions will do those things that help them do what they do faster, better, or cheaper. And,in that context, “better” means it helps differentiate them from other practitioners, thus bringing in more business. Similarly, it could be argued that establishing practices to immunize all children completely brings more business to the pediatrician’s office, so he will do that. Presto! Those numbers are better, and the variation is narrower.
As the authors point out, many measures are complex, with many parties involved. Colonoscopy is more widely done when someone else pays for it. Pre-operative antibiotics to prevent wound infections is more successful as an institutional policy that ignores the surgeon. (See previous posting here, “My Operation.”) This is of proven economic benefit to the hospital tho not to the surgeon.
“The practices of high performing states should be . . . disseminated among other states.” This assumes, of course, that the states are interested. (Been following the SCHIP debate?)
If we establish goals, we must apply pressure at appropriate points. Decreasing the number of coal-fired power plants would probably do more to reduce hospital admissions for asthma than increasing practitioner visits.
The NHQR report is a valuable benchmark, and Healthy Patients 2010 constitutes laudable goals. But neither has much to do with healthcare, per se.
Many, if not most of the AHRQ measures have nothing to do with healthcare, so any changes are not related to the quality of any healthcare provided. For example, whether or not a woman goes to an obstetrician in her first trimester has nothing to do with the actual care she might receive if she actually went. Factors such as insurance, income, education, location, transportation, etc. are more important influences on this metric. Also, the authors wring their hands over the increase in suicide rates, but it’s not clear from the NHQR that those who committed suicide ever received any mental health care.
The lack of improvement in other factors is hardly surprising. Practitioners and institutions will do those things that help them do what they do faster, better, or cheaper. And,in that context, “better” means it helps differentiate them from other practitioners, thus bringing in more business. Similarly, it could be argued that establishing practices to immunize all children completely brings more business to the pediatrician’s office, so he will do that. Presto! Those numbers are better, and the variation is narrower.
As the authors point out, many measures are complex, with many parties involved. Colonoscopy is more widely done when someone else pays for it. Pre-operative antibiotics to prevent wound infections is more successful as an institutional policy that ignores the surgeon. (See previous posting here, “My Operation.”) This is of proven economic benefit to the hospital tho not to the surgeon.
“The practices of high performing states should be . . . disseminated among other states.” This assumes, of course, that the states are interested. (Been following the SCHIP debate?)
If we establish goals, we must apply pressure at appropriate points. Decreasing the number of coal-fired power plants would probably do more to reduce hospital admissions for asthma than increasing practitioner visits.
The NHQR report is a valuable benchmark, and Healthy Patients 2010 constitutes laudable goals. But neither has much to do with healthcare, per se.
