Been wrestling with an interesting question of late as I help to develop a Healthcare X PRIZE– what do we want our health system to actually accomplish on a global scale (ie what should our incremental health dollar accomplish?)
If we are what we measure, what should we be measuring to determine what return we’re achieving for our healthcare dollar?
What metric would you use to highlight the improved outcomes of a better-performing health system?
Some thoughts I’ve heard:
- Death
- Major morbidity
- Hospitalizations
- Sick days
- QALY
- % “passing” President’s Fitness test
What do we want our health dollar to buy? Appreciate your thoughts!
Interesting news flash from the pharmaceutical industry, and another reminder why the choice of metrics is so important: Zetia (the other half of Vytorin) while lowering cholesterol, simultaneously increases the growth of plaque in the coronary arteries. How’s that looking for a price: benefit ratio?
While it didn’t appear clear what the overall outcome was vis a vis heart attacks and clinical outcomes, it appears to be a disturbing finding that brings into question the benefit of the drug.
A refresher from my article on metrics:
There are two types of metrics, process and outcome metrics. Process metrics are seen as means of getting to desired results, with outcome metrics being the desired results. Outcome metrics are the things that really matter– in medicine this would be rates of morbidity and mortality, with good patient experience also potentially a desired outcome.
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I was reading some of the letters to the NY times today and am still shaking my head about the faulty metric being used to measure the effectiveness of Medicare: low administrative cost.
Now, setting aside that the way administrative cost is measured still misses significant cost shifted to other parties (namely providers and DOJ), in theory, it still doesn’t make any sense to me.
When a chicken gets its head cut off, it also “benefits” from reduced administrative costs . Lots of activity, with no wasted sugar going up to the brain…is this the “efficiency” we want for our health system?
Similarly, the postal service “wastes” less on profit than Fedex. Yet, when you need your package to actually get there the next day (and know exactly where it is along the way), which one do you use? I thought so…
Quality is a buzzword in medicine today–unfortunately, its application is anything but a high-quality, well-designed approach.
There are many reasons why quality is hard, and many reasons why defining quality well may not be fair to existing players who are trying hard to do the right thing. In settings like these, there is no one right approach that fits everyone. Ironically, by having quality efforts led by the government (P4P) and major payers, we’re less likely to get it right than by having a number of smaller players seek to play objective, third party roles that maximize benefits for specific constituents.
Structurally, quality is hard because:
- There are no established benchmarks
- The only metrics that matter–morbidity, mortality, and patient experience– are complicated and seem largely uncontrollable
- There is significant money at stake for the “chosen”
- Politically, no doctor believes they are inferior
- Society favors heroic intervention over statistically avoided event
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