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Fixin' Healthcare

Wednesday, December 13, 2006

The Lifestyle Chronicles - Process And Outcomes

The quality measurement and health assessment group at the Center for Medicare Medicaid Services (CMS) has selected 22 quality measures to evaluate and rank hospitals. A study of hospitalizations during 2004 involving heart attacks, heart failure and pneumonia presents an intriguing view of this methodology. Moreover, these results suggest that health care functions differently from the extrapolated projections of clinical trials.

The difference in deaths associated with heart attacks over the one-year period was 0.5 percent less in the highest ranked compared to the lowest ranked hospitals. The difference in deaths due to heart failure between the best and the worst hospitals was 0.1 percent. The death rate from pneumonia was 0.5 percent higher at low-rated hospitals.

These are not the expected results and the descrepancy is sufficinetly important to merit further investigation. Undoubtedly, one or more procedural factors will be proposed to explain the findings but the possibility has to be considered that the current perception of health care quality is flawed.

Medical care has moved far into the realm of aggressive therapy based upon drugs, medical devices and surgical procedures. Data from clinical trials supports these forms of therapy. It is a logical assumption that clinical trials can be extrapolated to apply in the real world.

But, what if it doesn't work that way? There are many more things in the real world than can be accounted for in clinical trials. What if a significant difference in clinical trials becomes an insignificant difference in the real world? The variability in biological systems and human organisms is a difficult adjustment. And, there is the behavior factor on the part of patients, as well as health care providers.

Whatever the case, I do hope the Mandarins will take a good look at the basis for these study findings. They should consider the situation comparable to a phase IV trial where Mother Nature is the principal investigator. The task is to determine what she is doing. It may lead to an entirely different perception of health care.

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