@odenskrigare,
odenskrigare;95937 wrote:I hope we learned from this instance that mainstream medicine isn't out to kill people and isn't necessarily expensive either
You're right about the first and wrong about the second. We're not out to kill people. We are expensive --
very expensive. We're so expensive that virtually no one can afford health care itself -- people have to have insurance policies.
There are cheaper ways of doing things, and the costs can be attributed to a number of systemic issues (i.e. not just the human "value" of the care), but it's damned expensive no matter what.
---------- Post added 10-07-2009 at 11:39 PM ----------
prothero;95935 wrote:For instance hospital infection rates.
Was that really an infection? or
Just a little redness and puffiness around the wound a few days post operative.
The ones that generate quality reports are fairly well-defined. Catheter-associated UTIs, vascular catheter-associated bacteremia, post-CABG mediastinitis, these are not the most elusive things on earth to diagnose, and the variability in diagnostic accuracy is much lower than the actual variability in infection rates. Where I work they post the catheter-associated bacteremia rates on the door to every ICU, there for the patients and families to see. They do it because they're proud of their control measures.
prothero;95935 wrote: Hospitals at tertiary referral centers which take more severe, unusual, rare or complicated cases always have higher mortality and complications than community hospitals. It is very hard to correct for this.
They can by using "case mix index" measures. It's not perfect, but it's a fairly quantitative way of describing the severity of patients. In part this depends on documentation practices. Medicare reimburses at a higher rate for sepsis, because it's a severe disease -- but the word matters. If you document "sepsis secondary to UTI", that is sufficient for Medicare's audits, but if you document "urosepsis", the exact same disease, it is not.
At any rate, there are so many studies now that correlate surgical outcomes with the experience of the surgeon that subspecialty volume becomes yet another core measure that patients need to see.
prothero;95935 wrote:Public ranking of hospitals and physicians on the basis of this kind of data collection may not be the best way to impove quality or lower costs.
Well, it's a motivational tool for hospitals. I trained in Boston, and the competition was utterly vicious between hospitals there. They all want to be in the top quintile or whatever of hospitals nationwide for this or that measure.