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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

#51

Post by BrandonM »

ksjdj wrote: post #33
sjf wrote: post #25

Earlier quoted context omitted.

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

I got 6 stitches in Cambodia for a major cut on my arm. No wait, seen by 3 medical professionals (including a doctor), in and out in 15 minutes. Total cost: $15.

For me, that was a far better outcome than I would have received in the US for a similar condition. Of course, stitches are pretty well understood; I can't advocate for any other medical procedures in Cambodia.

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

#52

Post by nradov »

MarkMc wrote: post #46
nradov wrote: post #32

Earlier 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…

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…

No rational hospital administrator would ever agree to be judged on 3-year survival rates. The sample sizes are too small and there are too many uncontrollable confounding factors impacting survival for this to ever give statistically significant results. Did the patient die because his heart bypass surgeon was incompetent, or because he went right back to eating Big Macs as soon as he was discharged from the hospital?

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

#53

Post by cmdrfred »

coldtea wrote: post #44
cmdrfred wrote: post #12

Earlier quoted context omitted.

Its only a free market in ways that are convenient for them.

That has been the case with all free markets, ever.

Also every socialist or communist system. We have yet to resolve the corruption problem without culling the ruling class every couple of decades.

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

#54

Post by aladoc99 »

Hydraulix989 wrote: post #42
monkmartinez wrote: post #35

Earlier quoted context omitted.

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.

Every one of these proposed quality signals is prone to error. Publication history I would see as a negative quality signal. Less experience means more likely to be up-to-date on latest treatment techniques and algorithms. Reputation in the "Best Doctor" survey sense usually correlates with years in practice more than actual quality. The best indicator, in my experience, is to ask a nurse at that hospital who they would send a family member to for that specific problem. Even board certification does not hold great discriminatory power, in my experience. Analysis of these indicators would make for a worthwhile research project, but the more beneficial project would be to try to identify and disseminate those behaviors that form mechanisms of quality.

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

#55

Post by aladoc99 »

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?

Surgeons talk about a "look test" that refers to that certain something not captured by objective risk measures. A patient who doesn't look too bad on paper may look in person like they might not survive a haircut, let alone a valve replacement.

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

#56

Post by mtw »

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.

Have you looked at https://www.ratemds.com ? I was forwarded this recently and I found it very interesting

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

#57

Post by nickff »

mtw wrote: post #56
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.

Have you looked at https://www.ratemds.com ? I was forwarded this recently and I found it very interesting

I have used a similar service, and found the results to be helpful in finding a general practicioner.

Tracking revision and mortality rates for surgeons would be much more helpful. I have been told (by engineers who have worked on joint replacements) that some surgeons have revision rates well over 50% (and frequently leave patients with one leg longer than the other), while others have revision rates well under 10%.

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

#58

Post by turbulents »

aladoc99 wrote: post #54
Hydraulix989 wrote: post #42

Earlier quoted context omitted.

"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.

Every one of these proposed quality signals is prone to error. Publication history I would see as a negative quality signal. Less experience means more likely to be up-to-date on latest treatment techniques and algorithms. Reputation in the "Best Doctor" survey sense usually correlates with years in practice more than actual quality. The best indicator, in my experience, is to ask a nurse at that hospital who they wo…

The latest Freakonomics podcast addressed this issue as well: http://freakonomics.com/podcast/bad-medicine-part-3-death-di...

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

#59

Post by MarkMc »

aladoc99 wrote: post #55
MarkMc wrote: post #28

Earlier quoted context omitted.

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?

Surgeons talk about a "look test" that refers to that certain something not captured by objective risk measures. A patient who doesn't look too bad on paper may look in person like they might not survive a haircut, let alone a valve replacement.

The database can store both objective and subjective risk measures. If there is good evidence that a 'look test' can improve risk assessment, lets get the referring doctor to perform a look test and store the result in the database. In that way the hospital will not have an edge over the risk-adjustment model used in the study.

Edit: Many patients are already assessed by performance status [1]

[1] https://en.wikipedia.org/wiki/Performance_status

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

#60

Post by MarkMc »

bigchewy wrote: post #38
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…

> 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.

That is a good point - this thread has turned out to be more complex than I expected, and had I been a bit more open-minded I would have avoided the phrase 'blindingly obvious'.

Still, I'm not yet convinced this is an intractable problem. The New York Times articles says that patients are 3 times more likely to die at one hospital than another, even after controlling for patient sickness, income and age. This may be due to (a) a confounding variable; (b) a real difference between the quality of care provided by the hospitals. How much weight should we place on each possibility? Is it 50/50, or 60/40, or 10/90?

If you have to have a medical procedure and were told the survival rate of Hospital A is 98% and at Hospital B is 94% would you say, "there are so many possible confounding variables, this statistic will have no bearing on my choice of hospital"?

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