Never get sick in the Philippines.
Go to the Wrong Hospital and You’re 3 Times More Likely to Die
21–30 of 61 posts
Re: Go to the Wrong Hospital and You’re 3 Times More Likely to Die
#22Never get sick in the Philippines.
Can you expand on that?
Re: Go to the Wrong Hospital and You’re 3 Times More Likely to Die
#23Would saying "Go to the RIGHT hospital and you're 3 Times more likely to live?" be equivalent?
Re: Go to the Wrong Hospital and You’re 3 Times More Likely to Die
#24Would saying "Go to the RIGHT hospital and you're 3 Times more likely to live?" be equivalent?
Not really. Suppose 1 / 100 people die at a good hospital and 3 / 100 die at a bad hospital.
If you go to a bad hospital, you're 3x more likely to die. But if you go to a good hospital, you're 99 / 97 or roughly 2% more likely to live.
Re: Go to the Wrong Hospital and You’re 3 Times More Likely to Die
#25Re: Go to the Wrong Hospital and You’re 3 Times More Likely to Die
#26This is so frustrating for me personally - I recently had to choose between several hospitals without knowing anything about the historical patient outcomes for each hospital.
A hundred years ago a doctor named Ernest Codman suggested that hospitals should be rated by an "End Result System" [1] where paient outcomes were measured and compared, yet only now do we have the "first comprehensive study comparing how well individual hospitals treated a variety of medical conditions". And we still do not know exactly which hospital is best and which is worst.
To me the best way to judge a hospital is blindingly obvious: For each patient at admission, estimate the chance he/she will be alive after 3 years. For example, a 65-year-old woman who is a smoker, is overweight and has stage 2 lung cancer might have a 25% chance of being alive in 3 years. Then compare the predicted outcome with the actual outcome. For example, say both Hospital A and Hospital B both admit 100 patients with 20% predicted chance of surviving 3 years. If after 3 years there are 30 such patients from Hospital A still alive but only 10 such patients from Hospital B, it would strongly indicate that Hospital A is better. We could look then at Hospital A for ways to improve Hospital B.
What's so disheartening is that this process doesn't involve any special technology. It could have been implemented 100 years ago, albeit with less rigorous statistical methods. We spend a billion dollars on evaluating a drug which has a marginal, one-off benfit for a few hundred thousand people. But we ignore a process which is cheap and offers long-lasting benefits to millions of people. It seems that the medical establishment is too powerful in this case.
Re: Go to the Wrong Hospital and You’re 3 Times More Likely to Die
#27They 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%…
Another data point: 30-day mortality rates for high-risk acute heart patients are lower during the dates of national cardiology meetings, i.e. when the top doctors are away.
http://jamanetwork.com/journals/jamainternalmedicine/fullart...
Re: Go to the Wrong Hospital and You’re 3 Times More Likely to Die
#28They 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…
You seem to be saying that a hospital that doesn't want to take complex cases can more accurately adjust for risk factors than the people doing the study mentioned in the article. Is that right?
Re: Go to the Wrong Hospital and You’re 3 Times More Likely to Die
#29Earlier quoted context omitted.
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.
Someone will do them. There is a business model for surgeons who only take the sickest patients. Sure, in that case your numbers are worse, but that's the way you market yourself.
Re: Go to the Wrong Hospital and You’re 3 Times More Likely to Die
#30They 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%…
> Flip it around and it's 1.3% versus 2.1% -- definitely noticeable.
Flip it back around and it is a 0.9% reduction in survival rates. ;-)
I'm going to guess that hospitals aren't exactly the biggest factor influencing outcomes...