EBM vs CSBE

As the launch day of this year's health care report card draws near, I've been fighting the good fight on publishing volume data. Specifically, volume of procedures for low-volume surgeries such as esophageal and pancreatic resections. Working from billing data, I can find out how many times each procedure was performed in a given hospital for a given time period.

In some instances, I'm seeing a volume in certain areas that is under 10 for most facilities and then one hospital cleans up with 100 or 150. Is this qualitative data? Can anyone be reasonably expected to form a judgment from this information?

Sure, I can provide mortality rates, but at one death per year for most hospitals, what value is that? Surely if a hospital performs ten times as many procedures than the one next door, I can expect better outcomes?

In the normal world, of course the answer is yes. Midas will do a better job on my brakes, AAMCO will do a better job on my gearbox/transmission. In medicine however, it's not true until the literature says it's true. So until the community performs enough studies to validate the obvious, it's not defensible.

Even where literature exists showing better outcomes for certain procedures that are performed a certain minimum number of times, it's apparently not overwhelming enough to convince everyone.

This is the basis of evidence-based medicine, not to mention... science. Science is, after all, nothing but a bunch of measurements.

However, given that any practitioner will loudly declare medicine to be half science and half art, I hereby coin a term I've been using for quite some time:

Common sense-based evidence

Simply put, if Doctor A has done it once, and Doctor B has done it 200 times, Doctor B is more experienced. End of story. I don't need a $30,000 study performed to risk-adjust the patient mix.

Bolster the common sense with evidence, of course. I am the first person to say that no one measure stands alone. But failing to provide a complete picture is hurting the public and denying us the transparency we seek.

The report cards I work on I try to introduce enough data to allow the user to decide on the important factors and make an informed judgment. The medical community works exactly the opposite way: they want specialists to make the judgment and publish it in very expensive journals we can't afford to read.

I don't presume to know whether you care more about mortality rates, volume, or proximity to a Starbucks, but I'll continue to work as hard as possible to provide as much comparative data as I can get my hands on.

It is, after all, good common sense.‎