Sepsis is the number one cause of death in American hospitals–higher than cancer or stroke. Your chance of dying from a sepsis infection can triple if you choose a hospital that doesn’t have a good sepsis response team.
Care outcomes always vary from site to site and from caregiver to caregiver. For instance, if you have cystic fibrosis, your life expectancy can be diminished by a decade if you choose one of the lower success care programs for that disease.
But people don’t know where to go for best care for almost any level or category of care. That is the missing link in our healthcare delivery infrastructure. The least successful cancer centers will not get better if neither they nor the world knows how relatively low their success levels are. The world needs a scorecard for care performance that is mathematically sound and scientifically valid. It should only measure and report outcomes where outcomes vary and matter.
Enough of those areas exist now, but others still need to be created. The survival rates for each stage of each major cancer should be in a publicly accessible database, and patients with cancer should be able to consult that database to see where to go for best care. The database should also show clearly what the survival rates are for each major type of treatment for each stage of cancer. For example, surgery survival rates, hospital infection rates and cancer treatment survival rates would be a nice starter set for improving patient choices about care.
Such a database is entirely feasible, but we need people with authority and purchasing power to demand it. Employers, care purchasers, governmental care buyers and the new health insurance exchanges created under the new American health care reform act should all be insisting on these data sets.
The new computerized claims payment and medical record data sets can be modified easily to add the data fields needed. The new data fields just need to include key outcome phrasing, like “Did the person die?” Knowing this simple data can be a matter of life and death for individual patients.
Historically, the infrastructure of care delivery has taken a strong stance of resistance to any level of outcome reporting for two main reasons: caregivers did not trust the reporting process, and there was no reason for caregivers to report outcomes when everyone believed all outcomes were, in fact, identical.
Results are not identical and choices matter. Creating a new health care marketplace based on best care outcomes and optimal care results is entirely possible. It can be done and will be done if the market wants it done and is willing to pay for it.
George Halvorson is chairman and chief executive officer of Kaiser Foundation Health Plan, Inc. and Kaiser Foundation Hospitals, headquartered in Oakland, California. Kaiser Permanente is the nation’s largest nonprofit health plan and hospital system. This post first appeared on The Economist.com.
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Choosing the right hospital is important, even something as simple as the air filtration can have a huge impact on what bacteria you are exposed to. I agree that many factors should be publicly accessible. I wonder though how much such a database would incite unneeded panic.
The other dynamic that deserves attention in any discussion of infrastracture is the changing ecosystem of the healthcare industry…lots of strategic implications for ‘C’ level execs, governing boards and HIEs. For a peek into this perspective, see what Qualcomm and others are doing at http://tinyurl.com/4hcfbb6t
Comparing apples to apples
My last comments referred to a statistical approach to understanding sepsis.
The reason I’m using that condition is that it demonstrates that age adjustment may be critical for looking at external variables that we can control.
Wound care is much the same. We have to look at the costing variables once we determine what we can control (Avoidable mortality & morbidity.) There are times;however when we need to adjust for pre-existing conditions like Baker Ulcers. In that event, referral centers who accept patients with higher comorbidities must be stratified & compared with like centers.
We should not deter organizations from caring even if there is no cure. That will not be a reliable or a humane delivery system given our demography. 1/5 of us is over 65 and may need different care than younger patients.
> 40% increase in patients over 85 yo. but the overall mortality decreased 4% in 7 years.
a). Do you think that this is a marker for medical futility when EOL care should be optimized? b). Do you believe that staffing may have a role. For instance, are the staffing ratios of experienced MDs/RNs adequate outside the ICU on evenings/nights/weekends? c.) Should the Infectious Dz. group monitor patients > 85 yo & those with an indwelling catheter longer than 3 days?
It does seem like things are getting a better in this arena – in general, at least from what I’ve seen. In Utah we have maternity outcome reporting. That’s a good start. But I do think it’s very important for a patient to know how good a doctor and/or facility is at doing a specific surgery, job, or helping someone recover from a certain medical condition. That would simply make all providers better at what they do (making them compete for their patients’ business in an open-reporting market).
Jared Balis
Utah Health Insurance Agent
While we could work on infrastructure, we need to Fix our Broken Health Care System First by Shifting our Health Attitudes
Our health care system is broken, probably an understatement of the year. The cost we pay under this broken system is with both our health and our wallet. Are we getting our money’s worth? Perhaps yes, in managing diseases but not in managing health. We live with the belief that health care system is responsible for managing our health. I believe this fundamental belief has to change. Our health attitudes must shift to take on personal responsibility of managing our health just as we manage our financial health. How we approach our health has to change? Please follow this article at http://www.rakeshsethi1.com
This concept will never work if it’s motives are strictly driven by profit. (In regards to the post by(Dan Urbach MD ). The focus should be on delivering higher quality care and it should be understood enterprise-wide. One organization may choose to not report an incident based on the fact that if they receive a high grade on their “report card” then they will receive higher reimbursement for their services. There seem to be a high margin of error and inconsistency with your suggestion.
George,
Why did you fire Justen Deal?
Sincerely,
Mary
Hi! This is my first time to hear about this Sepsis disease and I am surprised it is even worst than cancer or stroke… Well good thing I have read about this blog. I agree that different hospitals have their own specialization and people should know about this to know where the right place to go for a certain illness is.
I certainly have no objection to this, Mr. Halvorson. But how about we concentrate on getting everybody access to some kind of medical care first, eh? THEN we can worry about getting all the rich people to the “best” hospitals and “best” doctors.
The centers with better outcomes should be able to charge more for their services (and actually be paid more).
And the centers with the best results should be able to sell their services to the highest bidder at market rates.