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Got Limited Data?

September 14, 2010
by Mark Hagland
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The results of a new study underscore the paradoxes inherent in providing patients with fragmented data

The results of a new study underscore the paradoxes inherent in providing patients and consumers with fragmented data. One of the oft-repeated truisms of healthcare consumerism is the idea that, once patients/consumers are provided with any kind of quality-related data, they will surge forward like Paris communards, shouting “Aux barricades!” (or at least the 21st-century English-language, tweetable version of, “Aux barricades!”). Yet reality is, alas, ever-so-much-more banal than that.

Indeed, as researchers at the Santa Monica, Calif.-based RAND Corporation, and at the University of Pittsburgh School of Medicine, have found, the three main characteristics that consumers have associated with better care on the part of physicians were not associated with a higher level of care quality. Those three characteristics were being female, being board-certified, and having graduated from a U.S. medical school.

“We found that the types of information widely available to patients for choosing a physician do not predict whether that physician will deliver evidence-based care,” said Rachel Reid, the study’s lead author, and a University of Pittsburgh School of Medicine medical student.

In fact, Reid and her co-authors found, since detailed information about physician performance is seldom available to the general public, patients have focused on such factors as board certification, educational history, and whether or not they had made payments on malpractice claims. Their findings, which appeared in yesterday’s edition of the Archives of Internal Medicine, found that the difference in quality between the physicians with the “best” combination of characteristics (female, board-certified, and a degree from a U.S.-based medical school) and those with the “worst” characteristics (male, non-board-certified, and degreed from a non-U.S.-based medical school) was only six points.

Further, even among those physicians with the “best” characteristics, the degree of compliance with clinical best practices ranged from a rate of 49 percent compliance with recommended care practices, to a 75-percent rate. Meanwhile, researchers found absolutely no correlation between malpractice payouts and compliance with clinical best practices, or between years of experience and compliance with best practices.

So, what does all this say? Clearly, we’re in the Cro-Magnon era when it comes to quality data. So, when will we find ourselves in a more mature stage in all this? It will most certainly take several years, even with all the requirements coming out of the federal healthcare reform legislation passed this spring. And what’s more, the data are going to have to be far more granular and far more meaningful as well.

Now, that having been said, some of the regional and national quality rating initiatives to date have been more sophisticated that the types of data examined in this study. But even so, there are both confusion and mistrust around this first generation of quality data on providers. I look forward to a day when the data being produced are both more useful and more reliable. And CIOs and clinical informaticists will be critical figures in moving their organizations forward to produce truly useful, meaningful data.

Has the healthcare consumer revolution arrived yet? Certainly not fully, but then again, once it does, it’s more likely to look like the Oregon Trail than the Commune of 1871: that is to say, more like a steady stream of covered wagons bearing pioneers along a dirt path through the wilderness, rather than an angry mob with overturned carts in the streets. The pioneers in this case, of course, will be the provider organizations whose IT and overall leaders will have cracked the code on providing consumers/patients with real data they can use meaningfully. The signal shout then will be, not, “Aux barricades!” but “O Pioneers!”

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Comments

Mark,
Thanks for taking on this measurement and consumer reaction issue.

One month ago, an opinion piece, " Quality Measures and the Individual Physician" by Danielle Ofri, M.D., Ph.D., appeared in the New England Journal of Medicine (363;7 August 12, 2010). In addition to a variety of negative, unintended consequences of public reporting of quality information, the article has led to subsequent reports clearly showing that the scores are driven by patient factors (disease burden, compliance, etc) and not physician controllable factors. She points out that "they merely measure what's easy to measure."

I think this simply further strengthens your point. We're still in the infancy of measurement and risk adjustment. In your spirit of allusion to barricades, I'll close with a quote from Jean Valjean "And so Javert, you see it's true. That man bears no more guilt than you." Translating that French to English, "until we have appropriate data, we should be careful to not impugn providers or provider organizations."  It makes the providers unnecessarily and unfairly Misérable.

Mark Hagland

Editor-In-Chief

Mark Hagland

@hci_markhagland

www.healthcare-informatics.com/blog/mark-hagland

Mark Hagland became Editor-in-Chief of Healthcare Informatics in January 2010. Prior to that, he...