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Monday, December 15, 2008

A Story About Quality of Care

Recently, Tom Daschle invited Americans to discuss health concerns. In the healthcare standards space, you'll find that most of us have a large number of stories to tell. Most of our personal stories in healthcare are about something that could have been done better. They feed our passion for better healthcare, and help us to formulate opinions on what is of strategic importance.

A new story entered my repetoire recently. My step-father died last night, after a long struggle to recover from open-heart surgery over six weeks ago. This was his second open heart surgery in two years. I'm still somewhere between Shock and Denial and the Pain and Guilt stage of grieving. As I go through these stages, questions go through my head on what we could have done differently to ensure he survived.

Two questions gnaw at me:

Was he getting the best care in the area that he could have? I cannot answer that question as well as I would like to be able to. Even so, my mother and I probably have better answers than most patients or their families would. I have a rather elaborate network of physician contacts located in that area and elsewhere. The gave me good anecdotal feedback on the quality of physician care provided by the hospital where his surgery was performed. My step-father has had heart problems for quite some time, and my mother was rather engaged to make sure he had high quality care. Even so, I feel like the amount of information we all had was really insufficient. What would have been most helpful to us would have been a simple listing by procedure of the success rate and number of patients treated at area institutions, classified by the risk category of the patient. My step-father would have fallen into the high-risk category.

Was his cardiologist was the best provider of care for him, or would another have been better? His most recent cardiologist determined that he had yet another valve failure, something his previous provider hadn't found. The newer provider could possible have found that problem in the workup for the open heart surgery he had two years ago. Might that have resulted in his survival?

How would I have objectively compared his two cardiologists? I would like to have seen how a similar case mix of patients faired for each provider. I don't know exactly how to measure success or failure, but others do. I would also be interested in comparing the costs for those results.

A logical outcome of how our health system works is that information about quality of care needs to flow through the entire system. When I'm purchasing health coverage, I really want to know whether my payer is providing the best possible healthcare for me and my family. We need to extend the measure of quality of care not just to the providers of care, but also to those organizations that manage and negotiate the costs and quality of the care that we can obtain. Payers seem to be willing to pay for performance. They should also be willing to report on their own.

As for myself, I think I will measure results by the stories I hear. Tell me yours.


  1. I am so sorry for your loss, Keith.

  2. Quite a while ago Paul Levy posted a brief analysis of what it would take to get statistically meaningful comparisons of hospitals and doctors even if you have complete access to records. It's surprisingly hard to do more than separate out the gross incompetents and the miracle workers.

  3. My condolences to you and your family Keith.