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03/09/2012

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Jonathan

I haven't read the Reihan article, but isn't this essentially the purpose of hospital report cards. Now I don't know the entire literature, but it seems that consumers find it difficult to interpret these measures when they need to choose a physician. Also for a lot of these report cards we use an outcome measure different from mortality (readmissions). Anyone know more about this?

Brad F

I think you missed the biggest factor of all.

Attribution.

If you are speaking of providers, see Table 1
http://www.nejm.org/doi/full/10.1056/NEJMsa063979#t=article

Just look at a chronically ill beneficiary. Who is responsible in the sea of providers?

If you are envisioning a future where patients subscribe to integrated systems--a long ways off for nationwide uptake, the system owns the outcomes. Easier to oversee..

However, if mortality, SMRs for inpatients are woefully inadequate, and as outpatients, who knows. Thats tough, probably too high a hurdle to use as meaningful outcome.
http://www.bmj.com/content/340/bmj.c2016

I am not saying impossible, just real, real hard. Lots of risk adjustment, lots of measurement tools we dont yet have, and registries and databases that are far from complete.

Brad

Bill Gardner

Great point, Brad. As Reihan said in his post, we have to shift to systems with salaried providers. That solves the attribution problem as well.

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