Go the Wrong "Doctor" and You're 3 Times More Likely to Die
Go to the Wrong Hospital and You’re 3 Times More Likely to Die
41–50 of 61 posts
Re: Go to the Wrong Hospital and You’re 3 Times More Likely to Die
#42Outcomes 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. Som…
"There are shit doctors and great doctors, but they all have one thing in common... the Dr. preceding their name!"
I usually look at a doctor's reputation, experience level, education, publication, etc. as signals for "quality." It CAN vary drastically, as in, one doctor might overlook a diagnosis or even mis-diagnose something that another, more experienced doctor would catch correctly.
Re: Go to the Wrong Hospital and You’re 3 Times More Likely to Die
#43Earlier quoted context omitted.
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 fam…
Maybe you will be surprised to learn that lobotomies are considered valid medical procedures to this day.
Re: Go to the Wrong Hospital and You’re 3 Times More Likely to Die
#44> 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.
That has been the case with all free markets, ever.
Re: Go to the Wrong Hospital and You’re 3 Times More Likely to Die
#45Would 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.
Thank you, that's almost crystal clear.
Suppose 1 in 100 patients (for X) die at the best hospital and 3 in 100 die at the worst.
Keeping percents the numbers are much less scare mongering.
Best: 1% die, 99% live
Worst: 3% die, 97% live
Re: Go to the Wrong Hospital and You’re 3 Times More Likely to Die
#46This 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…
Sorry yes, I accept it is more complex than I described. There is the possibility that (a) the hospital admitting a patient can assess patient risk more accurately than a university professor who specialises in risk factors; (b) the size of the hospital advantage is significant when compared to the real differences in risk between hospitals; and (c) the hospital takes advantage of its better analysis by turning away patients where the professor risk rating of the patient is higher than the hospital risk rating.
This is subtly different to your analysis in two ways:
1. The trouble with using survival or outcome ratings is that they effectively punish providers who take on the hardest, riskiest cases. Not necessarily - if the professor underestimates the risk in easy cases and overestimates the risk in hard cases it would give the hospital an incentive to take on the hard cases and turn away the easy cases.
2. The reality is that's it's impossible to accurately quantify all the different factors which potentially impact survival. In some cases we have remarkably detailed understanding of a broad range of risk factors - take a look at table 3 from page 23 in this [1] report on stem cell transplants. There are detailed odds ratios for patient age, ethnicity, karnofsky score, CMV status, disease type and stage, interval between diagnosis and transplant, year of transplant, donor match type, donor/recipient sex parity and donor age. More importantly, the professor doesn't need to be particularly accurate in assessing patient risk - she just needs to be as accurate as the hospital. (Or close enough that the difference would not give the hospital a significant advantage)
Can the professor get close enough to hospital accuracy when estimating patient risk? Two relevant points spring to mind: (a) In the book Thinking Fast and Slow there is a description of how expert analysis can often be matched by simple rules of thumb. (b) The book Superforcasting describes how some lay people are able to make better predictions than the CIA about future geopolitical events, despite having no access to classified information.
My gut feel is that the hospital would not have a significant edge over the professor. But I'm willing to be proved wrong - let's conduct an experiment where a doctor estimates the 3-year chance of survival for each patient at the time the patient is admitted to hospital, and a professor also makes the same estimate based only on the patient's database record. The winner gets half a million dollars. Wouldn't this experiment give us valuable insight in determining whether hospitals can game an End Results system?
[1] http://www.seattlecca.org/sites/default/files/content_page/2...
Re: Go to the Wrong Hospital and You’re 3 Times More Likely to Die
#47FWIW 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.
from the abstract:
Risk-adjusted outcomes were calculated after adjusting for population factors, co-morbidities, and health system factors. Even after risk-adjustment, there exists large geographical variation in outcomes
Re: Go to the Wrong Hospital and You’re 3 Times More Likely to Die
#48This 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…
> There are so many confounding variables that even trying to measure outcomes 90 days out is difficult.
Very much this. Two patients, same doctor, same proceedure, with somewhat similar medical backgrounds. Nearly the same progression in the hospital, and released to go home, and possibly to doctors that don't interact with that hospital.
Perhaps one is poor and sometimes skips medication. Only one starts eating healthily and starts exercise. One has a stressful home life. Maybe one, when the recovery isn't going as quickly as possible, starts mixing in alternative medicines but doesn't tell his GP. Maybe they were both women, in the hospital to give birth - and one got pregnant again in the first year while the other didn't. These sorts of things greatly affect the outcomes, but none of them are under the hospital's controls.
Re: Go to the Wrong Hospital and You’re 3 Times More Likely to Die
#49Earlier 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 reminds me of a relative who couldn't find a surgeon for his problem, because the first 2 thought he was a risky patient. Then the 3rd charged more.
And thinking about it, I realized how many projects I jumped in while others jumped out because, you know, they were risky in not succeeding...
Re: Go to the Wrong Hospital and You’re 3 Times More Likely to Die
#50FWIW 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.
from the abstract: Risk-adjusted outcomes were calculated after adjusting for population factors, co-morbidities, and health system factors. Even after risk-adjustment, there exists large geographical variation in outcomes
That means they adjust for things like that heart attacks in 80-year-olds are more likely fatal than in 40-year-olds, so a hospital serving mostly the former is expected to have a lower survival rate for heart attack patients.
They are trying to measure differences in effectiveness for similar patients. GP gives a possible explanation for such a difference : the hospital probably gets good at the kinds of things it does a lot.