Sunday, February 1, 2009

Why Medical Quality Programs Fail

In medicine, there are many facts and figures that can be easily measured. Here are examples of data that is being diligently recorded and scrutinized by medical number-crunchers across the country.

  • Hospital deaths
  • Volume of hospital and individual physician surgeries and medical procedures
  • Average # hospital days for specific illnesses
  • % of a physician’s practice who have undergone preventative medical testing
  • # minutes the gastroenterologist’s colonoscope spends within the colon (This is not a joke!)
  • A physician’s medical malpractice history
  • Automobile the physician drives. (This is a joke!)
  • # and % primary physician referrals to specialists
  • $$ that physician expends per patient per specific medical condition

I could have made this list a lot longer, but you get the idea here. Sure, you can collect and measure all kinds of medical data, but this doesn’t measure medical quality. Since the government and insurance companies have no reliable way to measure quality, they have opted instead to measure what can be easily counted, as if these are actual quality benchmarks. This is the fallacy of these ‘quality’ programs. Consider a hypothetical example. If Physician A has an 80% mammogram rate in his practice while Physician B has a 50% rate, is the former doctor a higher quality practitioner? Not necessarily. What if Physician B’s patients are not health conscious and don’t pursue preventative care? Is this the doctor’s fault? Of course, not, but he may be assigned a lower quality score anyway.

Next posting, what you can learn about medical quality in an art museum!



2 comments:

Anonymous said...

There is much written on the internet to suggest that Belgium has a system which might offer insight. I copied below from a site but hesitated to take up space by putting too much information on your site.

Belgium has some of the lowest rates of hospital bourne infections such as MRSA consequently the patient to patient infection rate is nil.

Michael Kirsch, M.D. said...

I thank you for the comment and agree we should be imitating others who have higher medical quality. I don't think we have to go as far as Europe, as there are many institutions here who are cracking the code against preventable complications. Reducing hospital infections is not an easy task considering that we still can't get physicians, nurses and hospital visitors to wash their hands. For many of us in medicine, reducing infections is not itself a sufficient incentive to change our behavior.

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