Tuesday, June 28, 2011

In Practice...

Would you like to learn new, possibly disturbing information?:
When heart attack victims are taken to hospitals that aren’t equipped to perform lifesaving procedures to open blocked arteries, standard medical guidelines recommend they be transferred to another hospital within 30 minutes. Yet only one in 10 patients is transferred in that time, a new study has found.

I had one thought, then I dismissed it for wrongness. The thought I had was that this sounds like awfully good information to share with everyone, right? That’s nice in theory, but then again—how does this help in practice? (Imagine the conversation with the EMT: “Oh, let’s go to Presbyterian—they transfer their patients according to—” [slumps over])

In this measure, as with so many, it’s hard to figure out how the accountability of the market figures for the individual consumer. Narrowly, this suggests the problems with radical transparency in actually changing health care in this country, but more broadly it suggests problems with accountability in general. If consumers aren’t to discipline hospitals that employ such faulty procedures, who are? Insurers and hospitals are locked in a constant battle and it’s hard to see the insurers being able to insist on and win demands to such forms of care. The key mover here is probably going to have to be the government through Medicare…

(Incidentally, on the information front: the problem isn’t that it doesn’t exist, it’s that it is available in incomprehensible form. Let’s take this LA Times article on a Robert Wood Johnson Foundation database: it says consumers might be able to make decisions about their local hospitals or physicians based on quality metrics. Unfortunately, it’s basically an aggregator of other people’s quality metrics, with no intent to make it usable—either design-wise (i.e. how presentable it is), or in terms of scoring which metrics are reliable descriptions of reality and which aren’t. Just because you have a lot of information does not mean it’s particularly likely to be useful for you.)

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