The Doctors Next Door

How Does Illinois Compare to the Nation in Healthcare Quality?

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I'll give you a hint, here's what our trophy looks like. 

I don't know if only two tweets is an accurate sign of interest or not but it seems my posting last week entitled, How Do You Know if You're Getting Quality Medical Care, didn't interest too many of you.  Maybe my spider web story reminded you that you didn't yet have your Halloween costume together and you ran off before sending the courteous "tweet". If that's not the case, then why would we care so little about the quality of our medical care?

Reading that last sentence over again, I realize how ridiculous it sounds.  Of course we care about the quality of medical care we receive!  So why do the websites I referenced in that post see so little use from the public?  Do we think that we are already equipped to judge whether we're getting good quality?  Is this like some adults-only content a la "we know it when we see it"? 

Surveys of perception of medical care among the public tell us a few things. I should have read these studies before sitting down to write that post.

In a 2005 national poll by the Kaiser Family Foundation, the majority of people surveyed agreed that nurses (84%), doctors (69%), and hospitals (64%) are doing a good job. Less than one-half thought that drug companies (43%), nursing homes (35%), health insurers (34%), and HMOs/managed care plans (30%) were doing a good job.

Another study done by the same group in 2006 showed that 36% of people in the US reported having seen information comparing the quality of different health plans, hospitals or doctors. Of those, only 19% used that information to make healthcare decisions. That leaves us with less than 7% of people that use quality reports to inform their healthcare decisions. This flies in the face of what we know to be widespread quality and patient safety gaps in our healthcare system. 

These gaps are best described in two Institute of Medicine reports, one of which celebrates its 10th birthday today!

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To Err is Human was published November 1, 1999 and told us that up to 98,000 people die every year as a result of a medical error. These incidents exact enormous human and financial costs upon our healthcare system, such as:
  • Loss of patient trust
  • Diminished satisfaction for both patients and healthcare providers
  • Lost worker productivity, reduced school attendance
  • Physical and psychological disability
  • Up to $29 Billion dollars (1999 figures) in costs due to hospital-based medical errors alone 

It is suspected that the costs of medical errors that originate in non-hospital healthcare environments are even greater. We find this segment harder to measure but since more people access outpatient medical care than inpatient care in any given year, the opportunities for error are truly massive. 

Two years after the To Err is Human report, the Institute of Medicine published Crossing the Quality Chasm.

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This report summarized the broad scope of quality lapses in our healthcare system related to both medical errors and the frequent failure to deliver care consistent with known best practices.

These reports have inspired me and many others to exert endless energy, creativity and scientific exploration directed at attempts to close this chasm. Then we were reminded of how close to home these problems live and how much further we have to go when the Commonwealth Fund State Scorecard (October 8, 2009) found Illinois in the bottom quartile at #42 in overall quality. Yikes!  We've got our work cut out for us.  And there's worse news. That's a drop from 32nd just two years ago. And this year Illinois ranked #49 in the rate of avoidable hospitalization. 

Are we getting worse or are others getting better at a faster pace than we are?  Probably a little bit of both. So who ranked among the highest?

#1 Vermont

#2 Hawaii

#3 Iowa

#4 Minnesota

#5 Massachusetts

#6 Wisconsin

#7 Delaware--won most improved (often the booby prize in

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sporting events, but I'd sure have welcomed this award in lieu of the dreaded #42) 

Vermont has a fabulous program called The Vermont Blueprint for Health.  It's been touted by healthcare leaders in Washington as an example we are all encouraged to follow. Similarly, in my last post, I told you that the whole state of Wisconsin has a project in which physician quality measures are viewable to the public online.  This project was originally funded through a Robert Wood Johnson Foundation grant entitled Aligning Forces for Quality.  I can tell you that on two separate occasions, I was part of a group that attempted to lead the Chicago healthcare community in application for this funding. We had really outstanding applications authored by really successful grantwriters, but to no avail.  The Midwest Business Group on Health has facilitated another activity with similar goals that may yet come to pass. 

It is important to note that the most common source of these woes is not that of individual failings but instead a result of the complexity and nonsensical design of our healthcare system.  I don't know any single healthcare worker who goes to work with the goal of doing a mediocre job.  We came to this profession largely because of a desire to be of service to people and to couple that desire with an aptitude for the medical sciences so that we might help people through the challenging life experiences of illness and pain.  The people I know and have worked alongside continue to hold this aspiration close as they pass through their days in a crippled healthcare system.

The paradox is that the best way we can help our fellow Americans in their time of need is to cure the ills of the system that is supposed to be there for them at such times.  So a number of us have learned some different skills and collaborate with people with whom we might not have expected when we first entered this profession. We collaborate with politicians, patients who know our lapses firsthand, lawyers, engineers, business people, and so on, in order to reorder the pieces of this healthcare system Rubic's cube in hopes to bring it all into some logical order that delivers outstanding results every time. It is and will continue to be a mammoth task. 

Help us, will you?  I write this not to invoke fear but to ask you to hold us to a high standard.  Be informed, ask questions, lots of them, at any time, of anyone--even your doctor!  There are opportunities to get involved.  Check out these organizations:

The Coalition for Quality and Patient Safety of Chicagoland

Consumers Advancing Patient Safety

Save the Patient

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The MRSA Survivors Network

 

 


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6 Comments

jackspatafora said:

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Reads like some good investigative reporting. One thing, however, is missing. That inevitably missing piece to the health care puzzle -- the personal dynamic between you and your doctor. When IT works you're inclined (and entitled) to presume the SYSTEM works. It's something like education -- both these professions are as much art as science. But art is hard to measure; even harder to legislate...

Dr. Carrie said:

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You are so right Jack. The personal relationship between you and your doctor is vital and MUST work. Even when it works really well, however, it's important to balance your trust in that relationship with a realistic perspective on both humanistic and systemic frailties.

jackspatafora said:

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OK, Doc, so where does that leave you on this complex reform being proposed by Obama. My son is a doctor and my daughter a nurse -- so I have some personal interests in this effort. But reform is a hydro headed monster with so many facets to it. Bottom line -- how do you see getting government to help at the same time it doesn't hurt...?

Dr. Carrie said:

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Boy you sure do ask the tough questions, Jack! I don't pretend to have all the answers. But since you asked, I'll give you my two cents. Remember these are not those Wheat pennies that are worth THREE TIMES their face value. They're simply ordinary pennies manufactured around 1989 when I graduated from medical school. First and foremost, we need partners in both the public and private sectors to step up and work together. Even under the best of circumstances, the result will not be perfect and, unfortunately, I expect our healthcare system to fall into greater dysfunction before it gets better.

I personally feel that the public option is neither a deal maker or breaker but the private insurance industry needs to work with us to enhance access, inspire quality and maintain continuity of benefits. Only under these circumstances can we do without the public option.

Here's some more of my thoughts from an old post. My three wishes for a better healthcare system.
1. Eliminate medical errors. Years ago, a seminal medical publication estimated that 100,000 lives are lost each year as a result of medical errors. That number doesn't take into account the many lives that are not lost but are forever changed as a result of such errors. The human beings that deliver medical care are largely caring and committed to giving just the right care every time, putting aside the occasional Nurse Ratched or her doctor version with whom you've had the pleasure. So don't get me wrong here. Our complex systems are just not always designed in a way that helps our caregivers create consistently excellent results. In Chicago, you're fortunate to have an organization called the Coalition for Quality and Patient Safety of Chicagoland (a program of the Institute of Medicine of Chicago) that is laboring to facilitate a safer and higher quality healthcare system in your community.

2. Strengthen primary care. There aren't enough of us. In societies and communities where primary care is strong, the quality of the care is better, the healthcare costs are lower and patients are more satisfied. Depending on who you ask, you'll get a slightly different answer as to the proportion of medical students that choose to go into primary care. Suffice it to say, it's a very low number and shrinking every year. There are several reasons for this, not the least of which is the huge differential in payment for primary care versus specialty care.

The Patient Centered Medical Home is a primary care initiative that promises to redesign primary care practices so that they can better serve the vital role they must play in our healthcare system. Financial incentives within our redesigned medical system must enable this transformation. It is definitely not business as usual.

3. Align the financial incentives for healthcare organizations with the production of excellent quality and safe care. It can be done. The current state is such that doctors and hospitals get paid for delivering more care, not necessarily creating excellent health outcomes. In fact, more care is one outcome of delivering poor care. These incentives are perverse and must dramatically shift. Much has been done in recent years to at least create some transparency so that the public can review some of the results of hospitals and other healthcare organizations. For example, check out Hospital Compare. Even better, a wonderful surgeon from the Harvard system, Atul Gawande, says it better than I possibly can in his New Yorker article, The Cost Conundrum. Talk about an insiders look at the healthcare system--this is a must read.

jackspatafora said:

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Let me put it this way -- if you're as gifted with your diagnoses as you are with your rhetoric, you're making a real contribution. What's sad, of course, is that good docs (like good teachers - my old profession) have become beans to the bean-counters. I guess this is sadly inevitable. And yet, the influence of the good doctors and teachers can still affect eternity ...

Dr. Carrie said:

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Thank you. Well said.

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