Dealing With Medical Performance Judgment

Earlier this week, I reported a story that dealt in part with the wide variation among Swedish hospitals in their use of proven treatments for acute myocardial infarction patients. Even though steps such as angiography to assess affected coronary arteries, rapid intervention in blocked coronary arteries, and treatment with drugs like beta blockers and angiotensin converting enzyme inhibitors have been know effective for several years, many of the Swedish hospitals in the study continued to lag in applying these measures to their acute MI patients as recently as 2007, the most recent year examined.

image courtesy The Historical Society of the Courts of the State of New York

And, said U.S. experts, there is nothing unique about Sweden. The same thing happens in the United States, too. And they offered a possible solution: More U.S. hospitals need to participate in organized data collection and feedback programs to help hospitals track the care their patients receive, their patients’ outcomes, and how the outcomes match up against similar hospitals. Feedback like this is considered essential if hospitals want to get better in the care they deliver, the process known as quality improvement.

U.S. hospitals that treat acute MI patients have access to a free resource to help, a registry run by the American College of Cardiology and the American Heart Association known as the ACTION Registry — Get With the Guidelines.

But while reporting the story this week, I learned a disturbing statistic that should not bet overlooked. Despite being free, despite being on the U.S. scene for several years, as of now only 557 of the roughly 4,000 U.S. hospitals that provide care for MI patients are members of the ACTION Registry — GWTG. That’s about 14%. The people I interviewed made it clear that ACTION –GWTG is not the only such game in town, so some hospitals may belong to a different registry and quality- improvement program, but most likely the vast majority don’t do this. As a potential MI patient myself, like any other adult, I found it pretty scary that I could well wind up treated in a hospital that does zip to make sure their treatment systems are up to date and that they provide the best type of care out there.

The message I heard earlier this month at the annual meeting of the American College of Cardiology, at a session on quality of care, is that hospitals not on top of performance data collection and the physicians who work there should find this scary, too, because they stand to soon get whacked by a growing demand by payers and regulatory agencies to grow more accountable or get out of the way.

“”The train is very close, and we’re standing on the tracks. Clinicians need to take responsibility for the clinical data and for variations in care and find ways to intervene,” advised UCLA cardiologist Charles R. McKay.

“We will all be judged [by administrative databases of hospital and physician performance] and we better figure out how to deal with it,” advised William S. Weintraub, chairman of cardiology at Christiana  Care in Newark, Del.

—Mitchel Zoler (on Twitter @mitchelzoler)


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Filed under Cardiovascular Medicine, Health Policy, Hospital and Critical Care Medicine, IMNG, Internal Medicine, Internal Medicine News, Practice Trends

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