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Go to the Wrong Hospital and You’re 3 Times More Likely to Die

nytimes.com

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Re: Go to the Wrong Hospital and You’re 3 Times More Likely to Die

#31

Post by madgar »

MarkMc wrote: post #28
et2o wrote: post #5

Earlier 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…

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?

Not the GP but I generally assume that a patient's actual doctors know more about that patient's physical body and how it will impact a procedure than some academics who are classifying/"coding" thousands of case files.

Re: Go to the Wrong Hospital and You’re 3 Times More Likely to Die

#32

Post by nradov »

MarkMc wrote: post #26

This 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…

It's not that simple, and it only seems blindingly obvious to you because you haven't actually worked in healthcare. The trouble with using survival or outcome ratings is that they effectively punish providers who take on the hardest, riskiest cases. We simply don't have enough accurate data. And many of the input variables aren't independent. The reality is that's it's impossible to accurately quantify all the different factors which potentially impact survival. So some providers find ways to game the system through metrics arbitrage.

That said, it's still worthwhile to gather and use it for quality improvement. We just have to be careful to treat it with appropriate caveats and look at qualitative factors as well as quantified metrics.

Re: Go to the Wrong Hospital and You’re 3 Times More Likely to Die

#33

Post by ksjdj »

sjf wrote: post #25
pavel_lishin wrote: post #22

Earlier quoted context omitted.

Can you expand on that?

If it's anything like getting sick in India expect misdiagnosis, over-prescription of drugs and prescription of drugs that are banned in the US.

samesies for cambodia

n=1 tho

Re: Go to the Wrong Hospital and You’re 3 Times More Likely to Die

#34

Post by monkmartinez »

nradov wrote: post #32
MarkMc wrote: post #26

This 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…

It's not that simple, and it only seems blindingly obvious to you because you haven't actually worked in healthcare. The trouble with using survival or outcome ratings is that they effectively punish providers who take on the hardest, riskiest cases. We simply don't have enough accurate data. And many of the input variables aren't independent. The reality is that's it's impossible to accurately quantify all the diffe…

Spot on analysis. The complexity of the human factor, for want of a better term, in healthcare is so hard to measure. I can only relate it to what I know. That is, I work with several paramedics that are just "good" at differential diagnosis. They would probably be excellent doctors, but life didn't deal those cards in. I also work with "meh" paramedics that, if given the choice, I wouldn't want taking care of my family. They do an adequate job to the bare minimum standard set, but they are not great by any stretch of the imagination. Both paramedics charge the same and carry the same title. Both could miss something critical, or not. The fact is they are both humans practicing paramedicine.

Until we automate the variability out of healthcare, we are stuck with inconsistent results. Consider that roughly 70 years ago, lobotomies were considered a valid medical procedure for psychiatric problems including anxiety and depression.

Re: Go to the Wrong Hospital and You’re 3 Times More Likely to Die

#35

Post by monkmartinez »

nickff wrote: post #4

Outcomes vary widely by doctor/surgeon as well, but the medical profession has successfully resisted meaningful measurement of results for many years now.

Agreed! There are shit doctors and great doctors, but they all have one thing in common... the Dr. preceding their name! They have resisted for good reason. I mean, when you have a bad day at the office, some code or deal or possibly something else breaks. When a surgeon has a bad day, it is not so simple and it is easy to forget they are human.

I have worked countless full arrest codes in the field... countless. Some go a lot better than others, and some are even successful. Most codes are do not end well for the patient whose heart has stopped beating or the drive to breathe has stopped. I can't imagine having stats of the codes we work pushed in our face everyday. There are sooooo many variables that we don't control which would make the whole "measuring" endeavor meaningless to anyone that really cared. From the weight of the patient to the cleanliness of the house are all variables that may or may not matter. Good luck controlling for all that!

Re: Go to the Wrong Hospital and You’re 3 Times More Likely to Die

#36

Post by pseingatl »

Do you think the Secret Service knows, for example, which hospital is best for gunshot victims? For stroke? For heart attacks? Of course they do. And yet, when Hillary collapsed at the 9/11 Memorial, they took her to no hospital, but to her daughter's apartment instead. Seems odd. Very odd.

Re: Go to the Wrong Hospital and You’re 3 Times More Likely to Die

#37

Post by wyclif »

sjf wrote: post #25
pavel_lishin wrote: post #22

Earlier quoted context omitted.

Can you expand on that?

If it's anything like getting sick in India expect misdiagnosis, over-prescription of drugs and prescription of drugs that are banned in the US.

Yes, this is what I had in mind. In addition to all that, treatment by medical "professionals" who may be quacks and/or have qualifications granted by diploma mills.

Re: Go to the Wrong Hospital and You’re 3 Times More Likely to Die

#38

Post by bigchewy »

MarkMc wrote: post #26

This 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…

any time a problem of this magnitude hasn't been solved AND you think the answer is 'blindingly obvious', consider that you don't fully grok the problem. I've been in healthcare analytics for 10+ years and it's incredibly difficult to measure outcomes. Take your example of 3 year outcomes, are you saying that the entire reason why someone is alive is because of the hospital they went to 3 years ago? There are so many confounding variables that even trying to measure outcomes 90 days out is difficult.

On top of that, the other commenter mentioned the unintended consequences of simplistic measurements like the one you describe. Look at measuring patient satisfaction - 'what could possibly be wrong with measuring patient satisfaction', people say! hold docs/hospitals/etc. accountable. but when you look at the data, patient satisfaction scores are weakly correlated with evidence based care and healthy outcomes but it is strongly correlated with things like how much time the patient sat in the waiting room or if the doctor prescribed them a medication.

Re: Go to the Wrong Hospital and You’re 3 Times More Likely to Die

#40

Post by [deleted] »

MarkMc wrote: post #26

This 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…

[deleted]
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