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When We Share Data, Patients Win

Posted By Administration, Thursday, August 13, 2015
Updated: Thursday, August 13, 2015

Hospitals and clinicians should be thinking about what comparative analysis of data can do for patients and for improving the safety of care. 


By Tejal K. Gandhi, MD, MPH, CPPS

  Tejal K. Gandhi  


Fifteen years ago, an Institute of Medicine report estimated that 98,000 people die every year in the US as a result of medical error. Today, while there is greater awareness of safety science in medicine, studies continue to estimate that thousands of avoidable deaths and injuries occur annually in medical settings.

One outcrop of the attention to this problem has been greater scrutiny of health care organizations and providers. Consumers have grown accustomed to seeing hospitals and physician practices ranked by various state, federal, and private report cards. At considerable effort, these organizations wade in to what was once a void—information about the safety and quality of our nation’s health care.

Yet even with these resources, consumers are not fully informed—and health care is still not as safe as it could be.

Now, the nonprofit news outlet ProPublica has entered this arena, releasing results of a years-long investigation into surgical complications at both the hospital level and the surgeon level. That’s right: they look at, and report on, the outcomes of individual surgeons.

Many consumers probably don’t realize how difficult it is to capture, analyze, and compare this kind of medical information. For starters, the data ProPublica used are not readily available to health care institutions, and even if they were, hospitals would need to employ statisticians to translate the data into useful information. There are services that provide analysis of a hospital’s own outcomes data, but if a patient is discharged from Hospital X and readmitted two weeks later to Hospital Y across town, Hospital X has no way of knowing about it. But if Medicare is paying for that patient’s care, Medicare knows.


Some hospital CEOs who review the ProPublica database (called the Surgeon Scorecard) may be surprised to find a surgeon with a low complication rate (a good thing) working alongside another surgeon with a much higher complication rate (a not-so-good thing). The refreshing angle here is ProPublica’s stated goal that these data should be used as a means to drive improvement. Let’s get Dr. A to talk to Dr. B and explain exactly how those good outcomes happen. And let’s get the hospital where these doctors work to improve and standardize its processes, training, and oversight to drive down variation.

To be sure, there are limits to the value of the ProPublica analysis. Using Medicare claims data, the investigative team narrowed their review to a group of relatively low-risk, elective surgical procedures and searched for two kinds of complications: death, or a readmission to the hospital within 30 days of discharge with a “likely complication of surgery.” They did, however, enlist the help of biostatisticians and noted researchers to control for confounding circumstances and try to perform appropriate risk adjustment.

There are those who argue about the validity of ProPublica’s methodology. Others may seek to point fingers and assign blame for higher-than-average complication rates. But those responses are misguided. What we need now is for hospitals and surgeons to think about what this kind of comparative analysis can do for patients and for improving the safety of surgical care. And we need to expand this kind of data sharing beyond Medicare and beyond surgery.

Earlier this year, the National Patient Safety Foundation’s Lucian Leape Institute issued a report calling for greater transparency throughout our health care system, as a fundamental precondition to patient safety. Only by openly discussing errors and problems with care can we get better. Greater transparency has the potential to facilitate better partnership with patients and improve learning between providers, across health care organizations, and with the public.

But health care organizations cannot do this work on their own. This level of data, and a useful analysis of it, needs to be more readily available and more timely for organizations to be able to effectively use it for improvement. We need Medicare, private payers, and health care systems to help move the needle on greater transparency so that it doesn’t require an outside news organization to shine the light on these kinds of issues.

Would greater openness about outcomes harm the reputation or finances of lower-performing hospitals and physicians? Perhaps, but what better incentive is there to work on improving? Variation between providers or organizations is not about shaming or blaming; it is ultimately a way to drive improvement and create better systems of care. By learning from high performers, we create best practices. By creating best practices, we drive out the variation. By driving out variation, we improve care, make health care safer, and reduce the toll of medical errors on patients and families.


What do you think of ProPublica's Surgeon Scorecard? Comment on this post below. Note: To comment, you must first register on the website. If you are already registered, you must log in to comment.


Note: Marshall Allen, one of the reporters who worked on the ProPublic project, moderated an interactive discussion of transparency around health care outcomes with the public at the NPSF Congress earlier this year. The Executive Summary of this session at Congress can be downloaded here.


Tejal K. Gandhi, MD, MPH, CPPS, is president and chief executive officer of the National Patient Safety Foundation and of the NPSF Lucian Leape Institute.

Tags:  transparency 

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