Millenson on the lack of real committment to patient safety. Acerbic and fantastic. A few quotes, but as they say in the blogosphere read the whole thing

If there is a quality crisis today, it certainly is not apparent from the actions of major stakeholders….

 

…on the fifth anniversary of the IOM report, the Institute for Healthcare Improvement launched its "Save 100,000 Lives Campaign." It is a wonderful campaign, even if four out of every 10 hospitals don’t participate. What does that say about the will to change?

…Imagine what might happen in the QI world if the head of the IOM publicly criticized by name those 40 percent of hospitals that declined to participate in the IHI safety initiative. Imagine if Congress reacted by holding hearings. Imagine if CMS asked the Joint Commission to investigate whether those hospitals were really as safe as they seemed to think they were. Imagine if there were class-action lawsuits filed. Imagine the impact this unprecedented kind of focused, multi-faceted pressure would have on the "will to change" and the cultural context of quality improvement. If you find this scenario unlikely, it may be because those promoting the quality agenda sometimes seem to display greater concern for those whose behavior they are trying to change than for those whom that behavior is hurting.

Eric Novack sees hope in the IHI’s 100K lives program which announced impressive results this week, and being Eric, he thinks that there’s a political message in there too. There’ll be more on his show this Sunday.

There’s an article out called “How We Die in America” which is from a new book called UNPLUGGED: Reclaiming our Right to Die in America, by William Colby.

The publisher is looking for a reviewer, so if you’re interested in reviewing a copy and having your review on THCB let me know by email

So in FierceHealthcare today my colleague John Irvine wrote this

Some hospitals have argued for years that patient satisfaction scores can be misleading when it comes to gauging the quality of the healthcare services they receive. After all, patients are only human, aren’t they? And can easily be swayed by factors that have little if anything to do with the true quality of care. A new study out in the Annals of Internal Medicine appears to back this view. RAND Researchers and a team from the University of California Los Angeles surveyed 236 elderly patients, asking them to rate the quality of the care they had received. The average response was 8 out of 10. Follow up on patient records determined that patients received the recommended care 55 percent of the time. Now those numbers may seem relatively unimpressive, but they are evidence of a something that many providers have intuitively believed. It will be interesting to see how this plays out.

That apparently struck a nerve with FH reader Ann Farrell. She wrote to me about this problem, and one senses a little frustration in her voice!

It drives me NUTS when people (smart people and even payors) confuse satisfaction with quality of care  – two things that are NOT THE SAME, and in fact many times not correlated.  In some studies patients getting ongoing excellent care are exposed to the health system more than their healthy counterparts thus have more opportunities for service gaps. People in this study’s satisfaction with plans decreased the more they received treatment, as good as it may be clinically. 

Quality of care has to do with the addressing underlying problems, i.e. getting diagnosed properly then improving status of  medical condition or receiving palliative care if no improvement possible .For example, my diabetes is being treated with best practices leading to optimal outcomes, lack of complications, etc. We know from recent market data that this only happens 55% (if my recall correct) of time. Consumers are by and large clueless about the actual quality of care they are receiving, and many unaware of the patient safety data, i.e. we’re killing close to 100K people a year, which is not only bad quality but introducing medical problems, e.g. nosocomial infections, or actively killing patients, e.g. drug errors. 

 

Quality of care and patient safety have nothing to do with service or satisfaction, which is often based on parking, food, access/TATs and perception of care providers, “does someone answer my call bell quickly when I need them?” You can have great service and woeful quality, or visa versa. When I worked with benchmarking data University Hospitals has better quality outcomes than community hospitals they competed with so patients tolerated bad service, i.e. waiting for hours in waiting rooms, etc. Now specialty hospitals and some community hospitals are delivering comparable care and differentiating based on improved service. So the fact that people still use the terms interchangeably is baffling. MOST patients haven’t known what the quality of their care is – the Internet is changing that in terms of better access to care standards and evidence.

 

Sorry, as you can see this struck a huge chord with me, we have to know what problem we’re tackling to solve it.  The industry confuses this.

For some reason the issue of quality, waste, doctors not providing optimal care, etc seems to be a contentious one on THCB. I personally believe that fixing the consumer satisfaction part of health care is easier to do and equally necessary than fixing the care process. But they are separate things (both of which the system deals with very badly). But what do I know? Feel free to have at it in the comments!

There’s a Games for Health Day on May 9 in Los Angeles, California. It’s on the subject of Games for rehab, pain distraction, and health promotion. Want to know more? Games For Health

Says here that Middle-Aged Americans are Sicker Than British. . Apparently at every class strata it’s true:

A higher rate of Americans tested positive for diabetes and heart disease than the British. Americans also self-reported more diabetes, heart attacks, strokes, lung disease and cancer. The gap between countries holds true for educated and uneducated, rich and poor. “At every point in the social hierarchy there is more illness in the United States than in England and the differences are really dramatic,” said study co-author Dr. Michael Marmot, an epidemiologist at University College London in England.

Part of the problem is that Americans don’t binge drink enough…at least I’ve always thought so and I think that’s what they’re saying here:

Britons have a higher rate of heavy drinking, but a higher percentage of Americans are obese.The researchers crunched numbers to create a hypothetical statistical world in which the English had Americans’ lifestyle risk factors. In that model, in which the English were as fat as the Americans, the researchers found Americans still would be sicker.

And the quasi-racist crap that certain Canada bashers put out about US outcomes being worse because of all our minorities—who have the temerity to be both poor and dark-sinned—skewing the numbers is also put to the statistical sword:

The new study showed that when minorities are removed from the equation, and adjustments are made to control for education and income, white people in England are still healthier than white people in the United States.

Now there’s a lot of pap in the article about how the US spends twice as much per capita as the Brits on health care and how come the results are so bad.  But as anyone reading THCB knows health and health care are only tangentially related, and you certainly shouldn’t expect a causal correlation between spending on one and good results in the other.

On the other hand this does raise a crucial question that’s very important to an extremely local audience for THCB. As I was born and lived in the UK for 26 years and have lived here for 17. So am I as healthy as a Yank or a Limey?