quality care shifting the focus from procedures to outcomes

Many involved in issues of public safety are reexamining the question of what constitutes proper documentation and reporting of medical procedures, and whether compliance with recommended procedures is as important as the outcomes of those procedures. Recent studies have examined the topics of procedural breakdowns, improper medical care and the reticence of physicians to report their own errors — or those of colleagues.

Reported Procedural Compliance May Be a Poor Indicator of Patient Safety

The government — specifically Medicare — has historically placed a heavy emphasis on procedural compliance when evaluating hospitals and medical centers across the country. The assumption appears to be that if doctors and hospitals report that they follow proper procedures, the quality of care they provide must be high. However, a recent study published by researchers at the University of Michigan found that high levels of (largely self-reported) procedural compliance are a poor indicator for low post-operative death rates.

In fact, the hospitals judged by Medicare to be following recommended treatment guidelines and proper standards of care recorded about as many post-operative deaths as hospitals whose procedures Medicare officials found lacking.

This isn’t the first study to reach a similar conclusion. In 2006, a group of researchers at the University of Pennsylvania found only a loose correlation between “performance measures” and “patient outcomes.” It is unclear whether these results suggest that procedural compliance does not play a large role in determining successful outcomes, or if reporting of procedural breakdowns — such as surgical mistakes and medication errors — is simply too unreliable to form the basis of an evaluation of the quality of care provided.

What is clear is that the compliance-based measures currently in place to evaluate hospitals may not be particularly useful at predicting success rate. This means that patients and their family members who may be worried about the quality of care delivered at a local Pennsylvania medical facility may not be able to rely on a high compliance rating to answer their concerns.

Making Bad Outcomes Public Might Be One Answer

Most hospitals in Pennsylvania and nationwide are asked to collect reports of death and injury during or related to medical services, but not all are as forthcoming in making this information available as one would hope.

The University of Michigan researchers concluded that one way to lower the rate of injury and death at hospitals would be to publicize these results — hospital-by-hospital — rather than to simply focus on whether or not staff members were reported as complying with accepted practices. The study seems to suggest that making the rate of bad outcomes public would at least provide consumers the information they need to make a more informed decision when selecting a health care provider.

Fair and Accurate Evaluation Is Important

Finding a way to fairly judge hospitals and medical centers based on injury and fatality rates is important, but it won’t be easy. There are many complicated factors to be considered – specifically, a way must be found to avoid penalizing those hospitals that routinely treat the most at-risk patients. What does seem clear from these recent studies is that rating medical facilities based solely on reported procedural compliance is not enough to give Pennsylvania families the peace of mind they deserve when dealing with a serious health care issue.

Source Article

  • Medicare Faulted on Surgery Evaluation (The Wall Street Journal)

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