Go to the Wrong Hospital and You’re 3 Times More Likely to Die
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Re: Go to the Wrong Hospital and You’re 3 Times More Likely to Die
#2They 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% -- definitely noticeable.
OTOH, UCSF (presumably top-tier, SF residents correct me if I'm mistaken) has 2.3% chance of dying. Maybe it's not a top-tier facility for AVR?
And further, a small midwestern hospital in Hays, KS (pop. 21000) has a 3.6% chance of death. That's huge next to Cedars-Sinai at 1.3%!
Re: Go to the Wrong Hospital and You’re 3 Times More Likely to Die
#3> 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"
Re: Go to the Wrong Hospital and You’re 3 Times More Likely to Die
#4Outcomes vary widely by doctor/surgeon as well, but the medical profession has successfully resisted meaningful measurement of results for many years now.
Re: Go to the Wrong Hospital and You’re 3 Times More Likely to Die
#5They 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 world.
Re: Go to the Wrong Hospital and You’re 3 Times More Likely to Die
#6They 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%…
[deleted]
Re: Go to the Wrong Hospital and You’re 3 Times More Likely to Die
#7Outcomes 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.
Re: Go to the Wrong Hospital and You’re 3 Times More Likely to Die
#8They 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…
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-Releases-201...).
Re: Go to the Wrong Hospital and You’re 3 Times More Likely to Die
#9They 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%…
You also have to consider that the Hays, KS hospital, being a much smaller hospital, has a much smaller number of cases. The confidence interval around that is definitely larger as a result. Not sure how much larger, but likely enough to make the difference statistically insignificant (town pop is 21k, heart surgery # is likely very low).
Put another way, a single death out of a small population of patients will have a larger impact on the statistics.
Re: Go to the Wrong Hospital and You’re 3 Times More Likely to Die
#10They 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…
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 actually change for NY hospitals that transferred cases or for the Cleveland Clinic.
This is absolutely something that happens and Cardiac Surgeons are all scientists to some degree. The results and risk adjustments are very well documented and they can determine them with a fair degree of accuracy. I’m not aware of the info for this particular case, but if they did risk adjust (the patient) it right - there are still a lot of other factors that determine quality of care (speed of delivery of service) and quantity of surgerys performed (if you don’t perform enough surgeries per year your quality suffers). Incidently, this is true for surgical staff (nurses) as well. If the surgeon travels to numerous to hospitals… the hospitals with the most surgeries performed will have better outcomes (after risk adjustment for them doing higher risk surgeries).