Thursday, June 3, 2010

Dartmouth Data under attack

In what will no doubt be a spirited debate the NY times (http://nyti.ms/a31hD3) has highlighted the Data Used to Justify Health Savings Can Be Shaky: http://nyti.ms/a31hD3

>>>>A report is used to show that Americans could save while maintaining quality, but that may not always hold<<

I am reminded of the quote from my math teacher: "there are lies, damn lies and statistics". His point at the tim was that figures can be manipulated to tell any story and careful analysis is always warranted. In healthcare this is very evident with the deluge of product sheets and "studies" designed to persude the medical profession that the latest drug is better than the current cheap generic.

Unfortunately in this case while there may be some refinement of the data necessary this should not cloud the essential point hammered home by the study and the investigators. Publishing the data makes institutions aware of variations in standards and cost of care that must be explained and will serve as the basis of of future reductions in cost of care and nationwide improvements in quality. 

Amongst other highlights in the study the link between higher utlilization and failure to improve outcomes is troubling: 
>>>>The evidence is that higher utilization does not extend life expectancy, and might be correlated with shorter life expectancy, compared with lower utilization. Therefore, sending people with chronic diseases to higher-efficiency, lower-utilization hospitals for their care could result in both lower spending and increased quality and length of life.”<<<<
It certainly provides caregivers as well as patient's data to base their care treatment decisions on.

We should debate the data but the nature and extent of the variations exposed cannot be explained away and point to the issue of incentive in US healthcare today. We incent the providers to do stuff. The more procedures, treatments and clinical tests you do the more you get paid. Coupled with the increasing squeeze on compensation levels and the drive to increased utilization can be easily understood. 

One of the six sigma core principles is that you cannot improve unless you have data and measure. The Dartmouth study and data while imperfect is a significant step in the right direction and should be embraced and used as a stepping stone in the long and winding pathway of healthcare reform. 

Posted via email from drnic's posterous