Quality Improvement (QI)

Fake News! Get Your Fake News Here!

One of the top stories of 2016 is fake news. Chances are, in 2017, we will continue to fall for these fairy tales. When people think Obamacare and the Affordable Care Act are two completely different entities, we know facts can dissipate quickly. Why are we duped so easily? These stories fit into a narrative we want to believe in, reinforcing our often insular views, where the echo chamber reverberates at high frequency. We digest only headlines and forward those along, not having time to fully read the stories. Lack of faith in the "media" causes us to trust any headline from any source over the mainstream media. Facebook is recognizing the large role it plays in dissemination of fake stories to the extent that it plans to roll out a new filter in Germany to begin to fight this epidemic. Here's how you and others can combat fake news…

Online Ratings For Hospital CEO, CFO’s, etc.

This week's NEJM features an article on hospital-sponsored online rating sites for docs.  The author, Vivian S. Lee, M.D., Ph.D., MBA, a prominent health services researcher discusses the adoption and success of her program at the University of Utah and how the system uses a portal open to patients to evaluate staff. In the piece, she covers familiar ground. Early renunciation and eventual acceptance by faculty in a manner you can predict: initial fears of reputation and prestige loss give way to a stable system allowing docs to obtain feedback in real time to improve their game.  It is not all wine and roses in her telling, but like all things, the apocalypse never materializes, and the once unthinkable becomes business as usual. Docs adjust.  Life moves on. Also in her viewpoint, she cites a recent study of interest that continues to get a lot of attention whenever inquiring minds consider provider ratings.…

Creating Value through Crowdsourcing & Finding “Value” in the New Year

Earlier this month, I took a day trip to the University of Michigan Frankel Cardiovascular Center for their inaugural value challenge. Little did I know that when I arrived, I would be part of an all-star judging team that would be giving away $100,000 (a.k.a. real money) complete with a “big check”, a la Publisher’s Clearing House, to the best idea to improve value! Given that I do not see patients on our cardiology service, I was starting to wonder if I was in over my head. The good news is that value was defined quite broadly by different stakeholders; I was able to follow along, even though I wasn’t up to date with the latest in intra-aortic balloon pumps. We heard from 5 finalists. Interestingly, 3 of the ideas centered on specialized teams to improve care coordination for specific conditions such as atrial fibrillation, pulmonary embolism, or cardiogenic shock. While…

Male Versus Female Hospitalists

If you have paid attention to the news, you picked up the study out in JAMA concerning how male versus female physicians deliver inpatient care.  Not just any inpatient docs, though, but hospitalists. The investigators were meticulous in their analysis of over a million Medicare beneficiaries and looked at readmit and mortality rates.  They examined various diagnoses and adjusted for the usual doctor and hospital characteristics. Across the board, males took a drubbing and the NNT for both outcomes of interest hovered around 200 (0.5% absolute difference). Ashish Jha, one of the investigators and a leader in the study of hospital quality and safety (who really needs to speak at an SHM annual, incidentally) goes into more depth over at his blog: (more…)

BREAKING NEWS: “Physicians Deemed Unnecessary”; “Social Worker Promoted to Hospital CEO”

“Physicians deemed unnecessary, ½ of all hospitals expect to be using artificial intelligence technology by 2020. Medical schools begin to shutter.” (See New England Journey of Medicine 2016.) “Social worker of inner city hospital found to be the most cost effective position in the system, promoted to CEO.” “Patients HCAHPS surveys determined to be filled out by their pets 90% of the time. Industry chief states this improves surveys have never been more accurate and recommends tying 100% of salary to Rover’s results.” (See webofliesmd.com for those last two.) So ran some Facebook headlines from my Macedonia buddy. Makes me long for the days of getting duped by The Onion. Fake news, as opposed to satirical news, is the latest virus infecting the web. They travel online faster than Usain Bolt. We are passed the era of truthiness and into the realm of post-truth. With newspaper subscription rates declining faster than ever, the search for real news gets harder and harder. Truth…
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