3 ms·

How can that be? A patient gets diagnosed. There's treatment. There's an outcome. That can't be measured? And assessed? There's data flowing all over the plac

How can that be? A patient gets diagnosed. There's treatment. There's an outcome. That can't be measured? And assessed? There's data flowing all over the place. But perhaps the lawyers and the insurance stand in the way of improvement?

rscho 4y ago
Insurance, precisely. Insurance companies are pushing for performance assessment to put pressure on prices. All well and good until you understand that you can't force hospitals/practitioners to all get a random sample of patients. So measurements are biased, and therefore people game the system. In practice, it means all healthcare providers will concentrate on easy cases to lower risk and maximize revenue. So as you see, free market thought doesn't really work in healthcare.
nradov 4y ago
It's not a legal or insurance issue, it's a data gathering and classification issue. There is no such thing as a standard patient. Especially when it comes to surgical procedures, everyone is unique. We generally don't have ways to accurately assess the impact of factors like patient age, fitness level, body composition, and co-morbid conditions. So instituting a quality measurement system like you describe would have the perverse effect of causing physicians to keep their numbers up by refusing to take the riskiest patients on at all.
giantg2 4y ago
There are too many variables. You could have two people with the same diagnosis but one has a complication. Even if you do everything 'right' the success isn't 100% because there are slight variations in people and diseases.
- chiefalchemist 4y ago
  Agreed. All the more reason to look for patterns of what works or what might not. The human body is complex. Why not look for as much help as possible?
  - nradov 4y ago
    We don't even know what all the factors are, and we don't have a practical or affordable way to gather and record all that data in a high-quality, consistent manner.
    - chiefalchemist 4y ago
      So we don't even start to try? That's not a good enough reason. Given the social and financial magnitude the excuse is nearly criminal.
      - rscho 4y ago
        We do try. But what we've got is not nearly good enough. You underestimate the messiness and overestimate the information retrieval capabilities of healthcare systems.
        chiefalchemist 4y ago
        Oh. I understand the healthcare system's systems are a shitshow. I've seen it first hand. FFS the staff isn't even aware of the importance of sleep (i.e., lights left on, TV left blasting). But. If they can identify the importance of hand sanitation and implement programs to ensure that, then there is hope. But as it is, it feels like the land of "that's how we've always done things." Note: this isn't only hospitals but extended care facilities. They're printing money on the backs of the suffering and losses of others. Do no harm?? Perhaps it once meant something. No much anymore.
      - nradov 4y ago
        It's always disappointing to see comments like this on HN by arrogant, ignorant technologists who haven't done their homework and fail to understand the complexities of healthcare delivery. Biology is a lot harder than software or engineering. There are many researchers working in this area but outside of a few limited areas they haven't succeeded in creating models that are useful for assessing the quality of individual practitioners. And that generally wouldn't even be useful since healthcare is a team activity where systems matter more than individuals. We can do somewhat better at measuring quality for larger provider organizations across patient populations. The NCQA HEDIS measures are evidence based and reflect current consensus on best practices. https://www.ncqa.org/hedis/ https://www.ncqa.org/hedis/
aidenn0 4y ago
One example of how it can go wrong: GP: This condition X is much worse than normal, so I'm going to refer you to Dr. A, the best I know in the field. Aggregate enough of this and Dr. A has worse outcomes on paper for condition X than everybody else, since s/he gets the patients with the hardest to treat coming in.

rscho 4y ago

Insurance, precisely. Insurance companies are pushing for performance assessment to put pressure on prices. All well and good until you understand that you can't force hospitals/practitioners to all get a random sample of patients. So measurements are biased, and therefore people game the system. In practice, it means all healthcare providers will concentrate on easy cases to lower risk and maximize revenue. So as you see, free market thought doesn't really work in healthcare.

nradov 4y ago

It's not a legal or insurance issue, it's a data gathering and classification issue. There is no such thing as a standard patient. Especially when it comes to surgical procedures, everyone is unique. We generally don't have ways to accurately assess the impact of factors like patient age, fitness level, body composition, and co-morbid conditions. So instituting a quality measurement system like you describe would have the perverse effect of causing physicians to keep their numbers up by refusing to take the riskiest patients on at all.

giantg2 4y ago

There are too many variables. You could have two people with the same diagnosis but one has a complication. Even if you do everything 'right' the success isn't 100% because there are slight variations in people and diseases.

chiefalchemist 4y ago
Agreed. All the more reason to look for patterns of what works or what might not. The human body is complex. Why not look for as much help as possible?
- nradov 4y ago
  We don't even know what all the factors are, and we don't have a practical or affordable way to gather and record all that data in a high-quality, consistent manner.
  - chiefalchemist 4y ago
    So we don't even start to try? That's not a good enough reason. Given the social and financial magnitude the excuse is nearly criminal.
    - rscho 4y ago
      We do try. But what we've got is not nearly good enough. You underestimate the messiness and overestimate the information retrieval capabilities of healthcare systems.
      - chiefalchemist 4y ago
        Oh. I understand the healthcare system's systems are a shitshow. I've seen it first hand. FFS the staff isn't even aware of the importance of sleep (i.e., lights left on, TV left blasting). But. If they can identify the importance of hand sanitation and implement programs to ensure that, then there is hope. But as it is, it feels like the land of "that's how we've always done things." Note: this isn't only hospitals but extended care facilities. They're printing money on the backs of the suffering and losses of others. Do no harm?? Perhaps it once meant something. No much anymore.
    - nradov 4y ago
      It's always disappointing to see comments like this on HN by arrogant, ignorant technologists who haven't done their homework and fail to understand the complexities of healthcare delivery. Biology is a lot harder than software or engineering. There are many researchers working in this area but outside of a few limited areas they haven't succeeded in creating models that are useful for assessing the quality of individual practitioners. And that generally wouldn't even be useful since healthcare is a team activity where systems matter more than individuals. We can do somewhat better at measuring quality for larger provider organizations across patient populations. The NCQA HEDIS measures are evidence based and reflect current consensus on best practices. https://www.ncqa.org/hedis/ https://www.ncqa.org/hedis/

aidenn0 4y ago

One example of how it can go wrong: GP: This condition X is much worse than normal, so I'm going to refer you to Dr. A, the best I know in the field. Aggregate enough of this and Dr. A has worse outcomes on paper for condition X than everybody else, since s/he gets the patients with the hardest to treat coming in.