Measuring Therapeutic Effectiveness and Cost–One Part of Better Care for All
Posted by steven_spear | Under Innovation, health care, high velocity organizations, organizational learning, process excellence Sunday Mar 15, 2009A linchpin in health care reform is measuring the efficiency and effectiveness of individuals and institutions in providing treatment. Another is measuring the effectiveness of different therapies for different conditions, presented in different circumstances.
As I suggested in a previous post, payers and patients are terribly disadvantaged in knowing whom to trust, without the advantage of performance data about therapist effectiveness. Pioneering providers who are learning how to deliver better care to more people with less cost and effort are disadvantaged because their achievements are obscured. The only beneficiaries are less well performing providers who ineffectiveness is hidden behind ambiguous indicators.
Just as we must measure the effectiveness of therapists, so too we must measure the effectiveness of therapies to treat various conditions presented under the variety of circumstances in which they occur (please see Letter to the Boston Globe editor in response to an article by Lisa Wangsness–”US System to Rate Health Therapies“–Boston Globe, March 2, 2009) . Absent data driven decision making, patients and payers are disadvantaged in knowing what best to do, providers are handicapped in choosing the best course of treatment for patients. Those who provide the best therapy don’t benefit from their inventiveness. The only beneficiaries are those whose own treatment’s ineffectiveness is obscured.
Related posts:
- Measuring Value-Added, not Compliance, Key to Health Care Reform
- Paul Kruman misses the point (again): Better care at less cost is the key…
- Outcomes Measurement: The Linchpin of Healthcare Reform
- Spear on Bloomberg: What’s health care reform missing? Quality!
- Krugman concedes main objection: In fact, more care needn’t cost more…
For measuring and rating health care the biggest obstacle might be the fact that no one reports honestly in medicine, and almost no one in health care is aware of that. For instance, surgeons write their own post operative reports and routinely declare them to be perfect with no complications even when permanent disabilities were the result. The way around that is to get the information from patients - epidemiology through crowd-sourcing. If you have a 12-year-old with diabetes, you could learn where other families with the same problem got help at what cost. If we get that information from experts reviewing medical records, we will never learn the most important information. For instance, no physician writes in the record that he/she was inebriated at work. Nurses almost never note that either. That can be learned only from the parents of the children who smelled his breath, listened to his slurred speech and watched him stumble.