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the problem here is that mortality rate is not correlated/normalized with the patient risk factor. the problem lies in the performance indicator itself, not str
by LoSboccacc 9y ago
the problem here is that mortality rate is not correlated/normalized with the patient risk factor. the problem lies in the performance indicator itself, not strictly people trying to optimizing for what they are asked for. it is likely inhumane to refuse patients that have slightly above average risk - even if there are some considerations to be had, like having replacement organs go to waste, but that is already covered by the donor lists queues - but given people can find themselves out of work for having bad mortality rates, optimizing for the performance indicator it's the only logical conclusion.
also, normalizing for the patient risk will likely just lead to people overstating patient risk, because once you reduce performance to an index, people will focus on what's measured before on what the intended goal for the measurement is.
- emodendroket 9y agoI'm not an expert in cardiatric medicine or anything, but couldn't patient risk be determined by objective factors like patient age and history of previous heart issues?
- newfoundglory 9y agoThis is like asking why software project estimation can't just be done by looking at the size of the project to be built.
- emodendroket 9y agoI don't see how the analogy works. The entire point is you have a medical record with objective characteristics that can be tied to the risk of any given procedure.
- newfoundglory 9y agoMy entire point is that isn't true at all - you have a medical record with some objective characteristics, but it is not possible to calculate the risk of a procedure based on that information. Just like in software, we have a project requirements document with many objective characteristics and we are unable to calculate the time required based on those characteristics.
- emodendroket 9y agoSo what is the risk calculation based on? Presumably the doctors refusing to do procedures they deem high-risk are not determining completely at random. The risk calculation doesn't have to be perfectly accurate, and it seems to me as though heart procedures are better defined than software projects. (And besides that, although software estimation is notoriously inaccurate, it is still done and written into contracts all the time, because it serves a useful purpose that outweighs its inaccuracy)
- iosDrone 9y agoAnother way of looking at it is that the patients who are refused treatment count as losses. So the current system is not actually maximizing wins, it's maximizing win percentage for doctors.
- alonmower 9y agoYa, I went down this line of thinking too. It does seem like this might too be a poor incentive because now doctors would operate on everyone to try and claim wins, even if the likelihood is exceedingly low. There’s probably some measure like “healthy six months from now” that incentivizes them to try in situations with high mortality where operating is the only chance to improve things but keep them from operating if the risk is too high.
- sin7 9y agoPhysicians already have good reasons to overstate the patient's severity. It's part of the payment formula used by CMS. But there are plenty of incentives not to lie such as jail time.