Comparative-Effectiveness Research Will Lead to Value-Added Healthcare

We’ve all heard about “comparative effectiveness research”. The new healthcare law, the Affordable Care Act, will establish a panel of professionals to determine which medical practices provide quality and value. I mean value not only in the monetary sense but also in the human sense; what is best for the patient and his own values and beliefs. Before we can determine what medical practices work the best, we must determine how doctors and hospitals are performing. As Dr. Harlan Krumholz says in a recent Forbes article, for big corporations the idea that “you can’t manage it if you can’t measure it” is an old chestnut. General Electric, Toyota and other companies have had data-driven quality-improvement efforts for years. But medicine–supposedly a more scientific profession–has been slow to measure itself.

Dr. Krumholz, a cardiologist, decided to track some patient results just to see how cardiology is performing. In 2004, he found that only one-third of hospitals were treating heart attack victims fast enough. Given permission from Medicare to study patient results he found, that aspirin was being given to only 75% of heart patients who should get it. He studied blood pressure pills called beta blockers and found that only half of the heart patients who needed them were getting them. In 1997 he found that half the patients hospitalized for heart failure returned to the hospital within six months after their first visit. These findings formed the basis of comparison of hospitals on Medicare’s website, hospitalcompare.com.

You see, in many instances despite having the most expensive healthcare system in the world, Americans are not getting the right care. In my opinion, it’s because these types of care are inexpensive (an aspirin) and don’t generate the revenue flow necessary for doctors to live their lavish lifestyles (angioplasty is more lucrative). Additionally, doctors don’t like to have their work graded-it’s shameful to be wrong.

Of course all clinical decisions must be guided by patients’ values and needs so, in this regard, the ACA goes one step further by creating a Patient-Centered Outcomes Research Institute that will extend Dr. Kumholz’s work in cardiology to other medical areas such as cancer and psychiatry. Patient-centered healthcare is a nice term, developing relationships between doctor and patient which fosters patient participation in their healthcare. However, it will only work if healthcare teams are trained in communication so they can be responsive to patient values, preferences and needs and ensuring that patient values guide all clinical decisions (Health Affairs 29:1489, 2010). These relationships must be cultivated and measured just like what Dr. Kumholz is doing with the clinical data.

A good example of lack of communication which led to expensive, unnecessary care is the disconnect between what doctors told patients about coronary artery stenting and what patients heard as reported recently in the Boston Globe. The heart patients at Springfield’s Baystate Medical Center all thought that stents used to prop open their arteries would prevent a heart attack while doctors reported that they told most of them it would do nothing more than relieve their chest pain. Communication is meaning and interpretation. It’s like a McDonald’s drive through: whatever you order isn’t necessarily what you’ll get. Healthcare providers must be trained to communicate which is much more than just speaking, it’s listening and being able to read body language. Train teams in communication and measure its effectiveness to get better healthcare.

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