The Lack Of Quality Reporting Standards In Healthcare Is Epidemic

Come on now, you had to know about this problem with healthcare quality reporting.  No?  Well don’t take my word for it.  I’ve previously written about the lack of standards when it comes to defining value in healthcare and how we really can’t blame patients for misunderstanding healthcare value.

And now, this:  a recent JAMA online first that talks all about how we don’t have standards when it comes to healthcare quality reporting.  Oh boy don’t we!

Once upon a time, I worked for an organization that claimed it had no catheter associated urinary tract infections or central line infections in the ICU for more than two years!

Was this organization incredibly adept at quality improvement initiatives?  No, not really.  Had it closed its ICU to patients?  (That may be the only way to truly prevent those nosocomial infections.) Nope, sure hadn’t.

Several issues were at play, including a stubborn refusal to diagnose those infections even when they were obviously present and contributing to patient morbidity and mortality.  Can we blame them?  I’m not sure…there are plenty of pressures to avoid “never” diagnoses from CMS.

I’m not saying that makes it ok to ignore these diagnoses, but it does make it more understandable.  Hospitals didn’t create these incentive games, after all.

In any event, a lack of definitions and reporting standards regarding quality endpoints doesn’t help!  Take a look and click the link below to review the latest JAMA take on just how many issues we have with standardization of quality issues.  One more reason our field is a decade behind others in terms of quality improvement.

Although hospitals and physicians are perceived as trusted entities, these organizations have an incentive to present themselves in a positive light. This conflict of interest should be less pronounced when outside entities, such as the Centers for Medicare & Medicaid Services (CMS) or the Leapfrog Group, report to the public about health care quality.Evidence suggests that some organizations may be providing potentially misleading information to the public. For instance, one hospital stated on its website, “Come to us, we have no infections,” without stating which types of infections were included, how this performance outcome was measured, or how long the hospital had gone without an infection.5 Even though there has not been a systematic study of the accuracy of the quality data reported by hospitals and physicians on their own websites, concerns are likely to increase with the number and types of measures now being reported (eg, patient experience, costs), some of which may be more meaningful to patients.The potential for misinformation is understandable given the absence of standards to guide the reporting efforts of hospitals and physicians.

Source: Transparent Standards in Quality Reporting by Health Care Organizations | Health Care Reform | JAMA | The JAMA Network

Patients don’t understand what “low value care” really means

…and can you really blame them?  I mean, after all, it’s REALLY tough right now for those of us in Medicine to measure “value”.  I wrote about the issue here and it’s a huge problem.  (Some examples of all the definitions of “value in healthcare” are shared here.)

Take a look at the excerpt below, and click the link, for recent survey info that indicates patients don’t fully get that concept of what low value care looks like.

Previously, I described a novel tool to measure healthcare value here…but let me tell you:  whether you like that potential measure or not, right now there’s no commonly accepted way to measure what value looks like in healthcare.

Can you blame patients for not understanding what “low value” care looks like if we, in the healthcare game, can’t get together on how exactly to measure value?  Nope, probably not.

The researchers found that two-thirds of those surveyed “had some sense of what low-value care might entail, though many were uncertain about the specifics.” Additionally:Many who offered a description of low-value care saw it in terms of only testing, not treatment.About 5% “anticipated that excessive medical care might harm patients.”About 1% made a link between low-value care and medical costs – either their own or the nation’s.Pages

Source: Low-value Care Misunderstood By Patients | costs, patient experience, value | HealthLeaders Media