FWIW local demographics have a non-negligible effect on a hospital's specialty. The nearest hospital to a retirement community will get more practice at heart attacks and strokes and the one in the college town will be good at dealing with alcohol poisoning.
Go to the Wrong Hospital and You’re 3 Times More Likely to Die
11–20 of 61 posts
Re: Go to the Wrong Hospital and You’re 3 Times More Likely to Die
#12> The study did not disclose which hospitals had which results. Under the terms of the agreement to receive the data, the researchers agreed to keep the identities of the hospitals confidential. Well that's not too useful for the patient oh I mean "consumer"
Its only a free market in ways that are convenient for them.
Re: Go to the Wrong Hospital and You’re 3 Times More Likely to Die
#13Outcomes vary widely by doctor/surgeon as well, but the medical profession has successfully resisted meaningful measurement of results for many years now.
Most surgeons do not do enough cases over their entire careers to be meaningfully compared to their peers. There was a big paper about this recently. The ratings are a sham meant to instill false confidence.
Can you link the paper?
Re: Go to the Wrong Hospital and You’re 3 Times More Likely to Die
#14They link to a heart surgery compilation by the Society of Thoracic Surgeons ( http://www.sts.org/quality-research-patient-safety/sts-publi... ) which is fun to explore. In metro LA, the top-tier hospitals (Cedars-Sinai, UCLA) have noticeably better outcomes than regular hospitals. The difference is like 98.7% of patients not dying versus 97.9% in a valve replacement ("AVR"). Flip it around and it's 1.3% versus 2.1%…
These ratings are not great because they incentivize doctors not to take more complex cases. They claim to be risk-adjusted, but in reality you cannot adjust for all possible risk factors. Lots of things in medicine are very unique. There's very little that's more complex than human disease. As a referral center for other referral centers, additionally UCSF will be getting some of the most complicated cases in the wo…
> These ratings are not great because they incentivize doctors not to take more complex cases.
This reminds me of a scene in the recent Dr. Strange movie where the main character -- a neurosurgeon -- turns down a case because it had a high risk of failure and he didn't want to tarnish his perfect record.
> They claim to be risk-adjusted, but in reality you cannot adjust for all possible risk factors. Lots of things in medicine are very unique. There's very little that's more complex than human disease.
Isn't it better to approach the problem by improving how we do these risk assessments so that the risk-adjusted ratings are fair, as opposed to leaving patients in the dark about where to get the best care?
Re: Go to the Wrong Hospital and You’re 3 Times More Likely to Die
#15Opens page, Looks for graphs, "Nope... no graphs...", Closes it
Re: Go to the Wrong Hospital and You’re 3 Times More Likely to Die
#16So 4 options:
1. make the good hospitals worse
2. make the bad hospitals better
3. combination of 1 & 2
4. ignore
Most people will want to choose 2 but inadvertently choose 3. When in reality we should have chosen 4.
Re: Go to the Wrong Hospital and You’re 3 Times More Likely to Die
#17Earlier quoted context omitted.
These ratings are not great because they incentivize doctors not to take more complex cases. They claim to be risk-adjusted, but in reality you cannot adjust for all possible risk factors. Lots of things in medicine are very unique. There's very little that's more complex than human disease. As a referral center for other referral centers, additionally UCSF will be getting some of the most complicated cases in the wo…
In a previous life I worked for cardiac surgeons - one of them was on a board for the State of Florida to research outcomes and how to publish them without affecting which cases are taken. In the case of one example where NY started publishing outcomes the difficult cases switched to the Cleveland Clinic. The outcomes appearred to increase in NY and decrease at the Cleveland Clinic, but risk adjusted rates didn’t act…
It's not that some surgeries are being shifted from one center to another, its that no one at all will do them, generally to the detriment of the patient.
Re: Go to the Wrong Hospital and You’re 3 Times More Likely to Die
#18Earlier quoted context omitted.
These ratings are not great because they incentivize doctors not to take more complex cases. They claim to be risk-adjusted, but in reality you cannot adjust for all possible risk factors. Lots of things in medicine are very unique. There's very little that's more complex than human disease. As a referral center for other referral centers, additionally UCSF will be getting some of the most complicated cases in the wo…
> These ratings are not great because they incentivize doctors not to take more complex cases. This reminds me of a scene in the recent Dr. Strange movie where the main character -- a neurosurgeon -- turns down a case because it had a high risk of failure and he didn't want to tarnish his perfect record. > They claim to be risk-adjusted, but in reality you cannot adjust for all possible risk factors. Lots of things i…
It's hard to just "improve the risk adjustments." The statistics aren't there.
I agree patients shouldn't be left in the dark. The most important thing is getting the best care. There isn't an easy solution.
However, I think the existing solution hurts patients (and I have seen these risk assessments first-hand numerous times).
Re: Go to the Wrong Hospital and You’re 3 Times More Likely to Die
#19Earlier quoted context omitted.
These ratings are not great because they incentivize doctors not to take more complex cases. They claim to be risk-adjusted, but in reality you cannot adjust for all possible risk factors. Lots of things in medicine are very unique. There's very little that's more complex than human disease. As a referral center for other referral centers, additionally UCSF will be getting some of the most complicated cases in the wo…
I agree that numbers can be gamed, and it's possible that private hospitals might be particularly motivated to do so. Indeed, probably these numbers don't make much sense for anyone outside a small medical community of insiders to assess. I'm not holding a torch for Cedars, but they are of similar stature for referrals AFAIK (not directly on-point, but indicative: https://www.cedars-sinai.edu/About-Us/News/News-Relea…
That's true, they are a high profile center in this field.
Re: Go to the Wrong Hospital and You’re 3 Times More Likely to Die
#20Earlier quoted context omitted.
Most surgeons do not do enough cases over their entire careers to be meaningfully compared to their peers. There was a big paper about this recently. The ratings are a sham meant to instill false confidence.
Can you link the paper?
I can't remember what journal it was published in and google isn't helping.
I found this for hospital-level comparisons (these should be much more accurate due to far larger numbers): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4250275/#!po=2....
However: "Most commonly reported outcome measures have low reliability for differentiating hospital performance."