The (Data embedded) part of this post is a new option (at least to me), care of the Community Health Data Initiative, which I wrote about previously.
The statement in this article:
Yet efforts to measure quality have focused predominantly on the clinical aspects of care, rather than on systematically meas- uring and improving patients’ experiences with care. This lapse seems indicative of a broader failure to recognize that these experiential attri- butes can translate directly into improved clini- cal outcomes for patients, often at a lower cost.
Caught my eye because of a wierd fracturing of the data I noticed when I was running it for @ReginaHolliday .
Take a look for yourself (again, thanks to CDHI and data.medicare.gov).
Here are national averages for clinical processes of care in hospitals:
Here are national averages for patient experience with care in hospitals:
Only top-box matters
Note, I only included the scores that are “top-box”, either 9 or 10 out of a 10 point scale or the answer “ALWAYS” to the experience question. Some people might say that this excludes the “sometimes” or “almost” answers, and I think the answer to this question is definitively answered by the Disney Corporations of the world (and read: If Disney Ran Your Hospital if you want the detail), who only look at the top-box score to judge their success. They think of % customers who rate them a 5 out of 5, and look for 90 % there, because that equals loyalty. Anything less is failure.
Clinical processes of care – 80′s to 90′s
Taking out the scores for fibrinolytic (which is complicated by factors like time/space/clinical condition) – these clinical things, which are “things you do to people” look like they are done most of the time. If these were scores on a medical school exam, they’d be A-, B+ not bad. Our hospitals deliver the medications that treat illness and prevent worsening of it. Note that there’s one patient experience-y measure in here – Home management plan of care for children with asthma – this isn’t a medicine you give to people, it’s a discussion that you have with people. The score there is 54 % on average. Let’s look at paitent experience now.
Patient experience of care 50′s – 70′s
So these are not “things you do to people,” these are things you do to empower people do something they mostly do on their own – heal. The highest score here is 80 % for “doctor always communicated well”. Look at the rest – pain control 68 %, would definitely recommend the hospital 68 %, always quiet at night 56 %. Let’s see, getting scores like that on a medical school exam might rate in the C – F range.
How do we feel about the difference?
I’ll leave that as an open question for people to answer in the comments. And I’ll also say that I didn’t really connect these dots for myself until I read Christine Bechtel and Debra Ness’ (of The National Partnership for Women and Families) excellent paper (based on information from this campaign: @better_care )AND I saw the numerical data (combined with a strangely photographic memory, I’ll admit). So I’m connecting them for you here.
From my own experience i’ve observed a lot more of “let’s make sure the beta blocker is on board” in hospitals than I have “let’s make sure we always communicate well to our patients and their families.” In terms of igniting innovation, this is good, no, great news, because it means that there are a lot of good ideas that haven’t been tried yet. An no matter what anyone says, not everything has been tried before.
The even better news is that innovating here will do things for American health care beyond anything we’ve dreamed of clinically – it’s a big statement, and I believe it – here’s my presentation on this subject.
