New York Regional Health Care Report Card Goes Live

I know, I've been quiet. It's been a while since I posted, and here's why:

First and foremost, I have been buried in data all summer, getting this report card out. More on that in a minute.

Secondly, I determined to take some time to myself this year, so I've taken a slew of short camping trips to spend time with my son, do some fishing, sleep in a tent and generally get some of the city out of me.

Thirdly, I finally had my appendix out after my third and final bout with appendicitis.

So, now it's out. It's online at http://www.nyshaf.org/hcrc and I'd like to take this post to explain how I think it can be used, what purpose it serves, and talk about some of the data involved.

The report card is split into two main sections, HMO and Hospital. In both sections the report is split up by groups of measures that can viewed side by side, some quality, some patient experience, some cost.

One of the main problems with public report cards is that the health data is so complex and so arcane it's practically useless to the lay consumer. Sometimes a lower score is better. Sometimes a higher score is better. Sometimes the score is a percentage, sometimes a range. Sometimes it's a vague statistic definition, such as "not significantly worse that the national mean".

Another big problem is the tendency to predetermine what "good" is, and then try to communicate that top the viewer. Health care providers may say that high quality is paramount, cost is irrelevant. An HMO may say that the best care is given by better high quality, low cost providers. Some people think high volume is a good thing, other's don't. The list, and the permutations are endless.

Finally, the overarching goal is to present as many of these public reports as possible in a single space in a single format. For this year's report we've combined 25 publicly available reports which you'd normally have to obtain from 25 different sources.

So I set about trying to determine how to take all these kinds of different data and represent them in a singular fashion that would be easily and quickly comprehensible, without implying a judgement or a ranking. More than one reporter asked me "which hospital is the best?" My answer is always another question: best at what?

One hospital may be the world's best for cancer treatment; is that where I should go for a scheduled C-section?

There is no best hospital, there is no best doctor, no best surgeon, no best HMO. But there *are* providers that are better for you and your individual needs than others.

So, goals set: translate complex data analysis into visual nuggets of qualitative information, and allow the user to narrow down the qualities and measures that matter to them.


What you see above is one category of HMO data. More detailed information is available with a click or two, but at a glance you can see that for customer service one HMO stands out as being highly rated, three are more or less average, and one has some issues.

At least, I hope you can see that. If not, I just wasted a year.

So how can a consumer use this report card?

Example 1: Heart Attack

I have never heard of anyone having a heart attack and stopping to consult report cards on where they think they should go.

However, once you're in the hospital, your loved ones can consult the report to see how well the facility you ended up at is faring at providing quality treatment. If anything stands out as worrisome, bring it up with your doctor.

Further, several of the measures apply to the care you receive after your emergency treatment. Medications prescribed at discharge for example, including aspirin, as well as smoking cessation counselling.

Mortality rates for heart attack are relatively flat, everyone is going to be pretty much "as expected". If your hospital shows up red for mortality, bring this up with the hospital staff.

You may be looking at a co-pay or even worse, you're uninsured. Use the average charges bill to get an idea of how much the stay will cost you or your employer. You can also see the average length of stay for a heart attack patient, and if it's shorter or longer than you think is right, raise this with your physician.

The overall point is that the level and standard of care can and will vary from hospital to hospital, and nowhere is perfect. It pays to be informed, and remember you are your best advocate.

Example 2: Choosing an HMO

Some employers will offer you a choice of two HMOs. If you or your partner has an ongoing condition such as asthma, have a look at which of the two HMOs available seem to be more on the ball for that condition. Then check out the customer satisfaction ratings for that HMO.

If you don't have a choice and your HMO plan scores poorly, then use that as a reminder to make sure you get the care you need by advocating for yourself. Have a look at the care provided by other HMOs and demand that same care from your primary physician.

If you have children, compare the two youth sections. In my county, only one HMO has all green for appropriate youth care.

Example 3: Appendicitis

I have a bit of personal experience here. I had the symptoms of acute appendicitis for a few days, and finally went to the ER after the symptoms didn't go away. i was a little atypical, and was in little danger of perforation, but nonetheless you may be able to do what I did.

I looked at the five hospitals nearest me, and compared the length of stay for an appendectomy, the surgical infection prevention score,a dn the price.

I'm price-sensitive even though I have good health insurance. The company where I work pays for the health care I receive, and the last two years have seen a steady increase in both the company cost as well as my family rate contribution to the plan. Further, all my co-pays went up significantly this last year.

Because health care is so often paid for with invisible dollars it can feel a bit like Monopoly money, you never see it, you never worry about it, you get a long, arcane bill that you never have to worry about. However, I know that if I can get an appendectomy at hospital A for $10,000 less than hospital B, I just saved the company money. Saving the company money puts more dollars in the kitty for my next pay raise. And being relatively young and by all accounts rather stoic, I'd rather have the cash up front than ploughed into a pool for a rapidly greying employee population.

In my county, appendectomy hospital bills range from $7,000 to $30,000.

Let me repeat that.

In my county, appendectomy hospital bills range from $7,000 to $30,000.

That's before the surgeon's and anaesthetist's bills.

I actually placed more importance on finding a hospital that had a low average length of stay with good surgical infection scores. I wanted somewhere under $15,000 with three or so days stay on average.

The hospital I chose actually had a poor score for timely antibiotics, so instead of choosing a different hospital, I questioned the staff when my first antibiotics were given and ensured I was less than an hour from surgery.

Example 4: Mother to be

Some women search for hospitals that are less inclined to perform a C-section. In my county, the C-section rate varies from 17% to 34%. That's double the rate. For primary caesareans, the rate goes as low as 11% at a hospital that also shows a high rate of vaginal births after C-sections, clearly a hospital that can help you have a natural birth.

Others may choose the scheduled C-section route, and look for a hospital that performs a good number of the procedure. You can compare the number of times the procedure was performed in a year at all your local hospitals, as well as the surgical infection prevention scores.

Looking to get home quickly after the surgery? Some hospitals have you stay for three days, others for five.

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In my next post I'll go into more detail about the different data sets including the different kinds of measures available, where we get the data from, and how accurate that data is.

In the meantime, I am very interested in hearing from anyone who has used a public report card similar to this one in a real life situation. Was it useful? Did it complicate things? Did you bring anything up with your doctor?

Finally, if you wish you had similar resources in your community, consult www.abouthealthtransparency.org/ and click your state. You can also check out www.consumerhealthratings.com/
‎ Full story...

Appendix Ultimatum

So, the old appendix flared up again, as of course it should. Same symptoms as before, it was evident what was coming. I left work, drove home, and prepared for my first hospital stay.


(Quick reminder for the uninitiated: I visited Hospital A in February with symptoms of appendicitis, waited six and a half hours in the E.R. until giving up and going home. I then visited Hospital B the next day and had the most awful day I've had in quite some time, culminating in me being seated on a gurney two corridors away from the E.R. outside the isolation room where a guy with full-blown tuberculosis and his wife were wandering in and out of isolation back and forth in front of me complaining of the heat. I've had a dodgy appendix for quite some time. Read the full story in all it's glory here.)

I gathered a book, a change of clothes, and the average length of stay for the five hospitals closest to me - not including hospitals A and B from my prior sojourns. I then had a good night's sleep in my own bed, and mentally prepared to lose myself to the system for a few days.

I saw that my hospital of choice had lower than desirable scores for infection prevention, so I made a note to bring it up when antibiotics first appeared.

My plan was to hit the 8 a.m. shift change, but my subconscious desire to not go to the hospital had me pacing the living room until nine, so I didn't get to the hospital of choice until ten. Nonetheless I was triaged within 12 minutes and was seen by a doctor within another 15.

Emergency Preparedness

The E.R. proper was impressive; clean, lots of open space, certain areas were labelled - such as the asthma section. The doctor who saw me was amazingly friendly, very informative, listened and heard the story of my history with appendicitis and it's atypicality. I drank the stuff you need before going for an MRI and was confirmed to be suffering from appendicitis by around 3 p.m.

I was told that I'd be admitted to the E.R. and therefore settled in for the wait.

It should be noted that this whole time I was in my regular clothes. No gown. Clothes. I cannot begin to describe the difference compared to sitting in Hospital B in February all day in a gown.

I was in the E.R. up until around 7 p.m. During the entire day, I felt like I was in a place that was very aware of its patients. My E.R. doc was fantastic. Checked on me every once in a while, I received regular updates about my status. Around tea-time the learner doctors began arriving one after the other to poke and prod.

I was given a form to sign that acknowledged I had received various forms and information. I asked for the said forms and information, but was told I would receive it the next day. After a brief exchange of dry sarcasm, I elected to shut up and sign the release, making a mental note to see when the information actually arrived.

It was given to me two days later.

As the reality of surgery became more and more present, I asked the learner doctor surgery chap who was taking all my details down about how I could remove my appendix home with me. While it may seem odd to some, I am part of a large group of people who actually want to keep their hands on the bits that come out of us. I asked earnestly about my ownership of my slated-for-removal organ, and even offered to go halvsies on it so that pathology could have something to look at. I asked two different surgery doctors to check on this for me, I never got an answer nor did I see those doctors again.

Slowly, as my status was swinging from profitable E.R. visitor to run-of-the-mill appendectomy last thing on a Friday night, I became less of a customer and more a vocal cadaver.

Special Ops

Looking back, the thing that really peeves me is that no-one ever told me what was going to happen *after* the surgery. I did not know I was going to be shaved "down there".

I did not know I was going to wake up with tubes up my nose and another down my throat into my stomach. I did not know there would be metal staples in me. I did not know I would spend the night in a recovery room full of other people.

None of this was impossible to deal with, but knowing it beforehand would've made waking up after surgery a whole lot easier.

Seems to me that pre-op I should be given a one-page handout along the lines of "Appendectomy for Dummies" that covers what they're about to do and what things will be like after.

One page. A couple of paragraphs. That's all I'm asking. I don't want half an hour with a very busy surgeon stroking my hand and reassuring me. Just give me the handout.

So I woke sans appendix. The operation took longer than expected as my appendix was reluctant to leave, for which I feel proud in a silly way. The surgeon chap, when trying to impress upon me how aberrant my appendix was, exclaimed "that was one ugly appendix", at which I was offended in a silly way. It was twisted around and clinging on, he described it as having to "peel it off out of there".

The first 24 hours were simply uncomfortable as I had this pipe down my neck. I finally made it to a room, where I experienced my first real time in a hospital bed.

Overall, the stay was great, everyone was polite and friendly. The only real grumble I have is that the surgeon was very obviously agreeing to anything I asked like "please take this pipe out of my stomach" or "let me eat some ice chips" but he had no intention of doing so, which he could have just said so instead of trying to placate me.

For example, he told me the pipe could come out within the hour, left the room and gave no such order. This happened three times, all the while he actually wanted the thing in there about 36 hours. He told me this after it was removed, along with why it had to be in there for so long in the first place.

Information I could have really used, say, 36 hours ago.

Feed Me

Due to my atypical presentation, the guy wanted me in hospital for four or five more days. I worked really hard on walking around, looking healthy, and passing gas "back there". Given that I chose the hospital based on their apparent ability to kick people out relatively quickly, I felt I should give it the old college try. The surgeon really wanted me to stay in, but after talking to the resident who was visiting me, the surgeon came by eventually and checked me out. Again, I really felt listened to, like what I was saying was relevant, that I knew my limits and capabilities, I knew my body, and I felt like I would recover better at home. I was passing gas "back there", I was walking around unaided, I was peeing like a racehorse. The guy let me go home, albeit reluctantly and with many cautions about when to come back if such and such happened, but the point is they listened to me and let me go home.

Either that or someone googled me and figured they should let me go before I caused a scene

By the by, why is the no Internet in hospitals? I worked every day checking E-mails, I would have loved to do some research on recovery from appendix surgery, check the rugby. I was reduced to working on my phone which is mind-numbing after any decent amount of time. Get some wi-fi people! We'll pay for it, don't worry, you can bill it to the room just like the TV.

Three days later, when I was becoming ready to kill the next passing orderly for a tub of strawberry jelly, the senior resident for the day, after having asked me about 15 times if I was passing gas "back there" agreed to let me get some "clears", code talk for jelly, stock and tea - which in American means Jello, broth and... tea.

UK jam, US jelly
UK jelly, US jello
UK stock, US broth
UK broth, US chunky soup


I was so concerned that these orders wouldn't be passed on I ninja'ed the "Nil P O" (no food by mouth) sign above my head and removed it to the wastepaper basket.

That lunch time I received a tray with two jellies, a bowl of beef stock, a cup of tea and a bread roll which certainly doesn't seem clear to me but I wasn't about to give it back.

Never has a bowl of beef-flavoured water tasted so good. Three days without food is cruel and unusual in my book.

Nailed To The Door

All in all I'm glad the appendix is out, I wish I had it at home, and the hospital experience was middling. The E.R. was truly great. Everything else was vanilla. Maybe it all comes down to who's on duty that day. I don't know. I know I'm writing a letter to the E.R. doc and her boss to say thank you, they really exemplified everything I want to see when I'm in the E.R., I couldn't have been happier or more pleased with the care.

The only truly awful moment came on my third night when a roaming minstrel was allowed onto the floor and he minced from room to room with his guitar taking requests and singing to the patients. It was bad in a comedic, wincing kind of way.

I half hoped he'd break a string so I could make a luthier reference, a joke I'd been crafting for just the right moment, but the chance never came.

Ah well, it was a stretch anyway.








‎ Full story...

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.‎ Full story...

Doctor No

Scanning the health blog universe I wandered across a post on Kevin MD about a council on aging member urging the elderly to demand more than five minutes of a doctor's time if it was needed. What follows is an anonymous comment that appears to heve been made by one such doctor.

1. You are not paying them. You have shrugged that responsibility and the right to represent you onto the government and whatever secondary insurers you have hired. You are entitled to have what they pay for on your behalf, not whatever you want.

2. If you are the sort of person who wants that extra time you feel entitled to, then don't complain when you get seen later than your appointment time. It may be hard to think of someone besides yourself, but imagine for a moment an entire patient schedule of patients like yourself, all feeling entitled to a little more than what they really have paid for. Bring a book.

3. Enjoy bothering the staff? In my office, you will enjoy that just once. They are hard to replace. I want them to stay and if possible , stay happy. You, the botherer, can be replaced easily. It isn't rocket science to run that algorithm. Learn to be nice, even if it kills you.

4. Medicare is not the same as you paying for something, like a dinner. Electing to bestow your custom on a practice, your Medicare custom that is, is not an example of free give-and-take. Ever wonder why many practices limit the numbers of new Medicare patients? It isn't because they're getting rich seeing them, that is for sure. No Medicare heavy practices are worrying about back injuries while carting all the cash out the back door, that is for sure. No one says you need to grovel, but you should get real about what you are and are not bringing to the table. Oh, and your good word and its value in drawing other seniors to a practice? Everyone likes to be spoken well of, but it isn't the bonanza you might think it is. Every Medicare-aged patient has the potential to displace a better-insured patient, if you want to think of things that way.
# posted by Anonymous : 10:46 PM

There's so much that's wrong with that comment, but I'll address the one thing that stings:

Medicare is not the same as you paying for something, like a dinner. Electing to bestow your custom on a practice, your Medicare custom that is, is not an example of free give-and-take.

Utter nonsense. Keeping consumers tied to this belief is propping up a fetid market. Airlines, restaurants, car rental agencies, IRAs, supermarkets, all compete for dollars that you don't have in your hand. They seem to understand that the decision maker, not the payer, is the customer. That's what we're missing in health care. Consumer empowerment begins with us understanding our purchasing power.

To the doc who wrote the above, I challenge you to send your feelings above to each and every one of your bread-and-butter Medicare patients with a list of other doctors, and willingly lose a large percentage of them. Posting anonymously on the Internet may have made your feelings a little better, but I feel sorry for your patients who are unable to evade the system and remain on Medicare and feel they are being adequately cared for by you.

What happened to the word "care" anyway? This doc obviously doesn't "care", yet we call it health "care", "care" givers, it's baloney. Avis cares. Hilton cares. Jetblue cares. My mechanic cares.

Bring back care to health care, and we'll cut back on the apparently-untenable bothering of you and your staff.
‎ Full story...

Note to Pharmacists

Stop pressing my buttons! It's my question, I'll answer it!

The last three prescriptions I filled I encountered the same complete lack of customer service that is really beginning to peeve me off.

During checkout, here in NYC at least, after the money has changed hands the little screen pops up a screen that allows you to respond "No I do not need advice" or "Yes I received advice on my medication" or something to that effect.

Each of the last three times, the person handling the transaction leaned over and clicked the "no I don't need advice" button for me.

Un-flippin'-believable.

The first time was an independent pharmacy where I was getting my son's first ever dose of penicillin and yes, actually, I had some questions. I was worried about an allergic reaction as this would be the first time to find out, and I wanted to know the signs to look for if things were going wrong. "Instructions are in the bag" I was told. This was after the lady had clicked the "no I don't need advice" on the little touchscreen I put my PIN into.

The second time was at a Rite-Aid. I picked up some antibiotics for the boy but in fact had no questions so I was only mildly annoyed when the chap reached over the counter and hit the "no advice needed" button.

An hour later I was back to pick up my Chantix prescription for which I did indeed have questions and was subjected to (a) the checkout process completing before I was told they couldn't fill the whole three month prescription and (b) hitting the "no advice" button for again!

Drives me mad. Is this limited to New York or does anyone else experience this? Maybe it's just my face, maybe I look like someone who doesn't want to be helped.‎ Full story...

Ineffective Efficiency

NYT has a section today on "who pays for efficiency", several articles and a handy flash map from Dartmouth Atlas look at cost of care around the country, disparities in coverage and reimbursement, and the price of efficieny and who ends up paying versus who ends up benefitting.


‎ Full story...

My Mechanic vs My Doctor

My mechanic is a great guy, I've been using the same guy for years now. Not only is he up front about what's needed, what's not, and how much it will all cost, but he drives the exact same car as me. This very morning, after hitting a pothole this weekend, I dropped my car off and described the excitingly new squeaking and clunking emanating from the left hand front wheel well. He calls me within the hour to confirm his suspicions: I broke a stabilizer rod, the very same thing happenend to him only two weeks ago and helped him diagnose my problem.

Listening to NPR this weekend, I was interested to hear my favourite finance news show cover the news about a doctor's group in California publishing the prices they charge for common office -based procedures such as EKGs, vaccinations etc. A brief point counter-point ensued wherein a pro-transparency lass made a statement about how great pricing transparency is and someone else who doesn't think so said so, stating:

"Shopping for a doctor is not shopping for procedures, it's shopping for a person, someone you can trust, who understands your priorities, someone you can develop a relationship with".

Hence, the logic seemed to be, price doesn't matter.

I got to thinking about my trusted mechanic. I didn't shop for him by price. He came highly recommended and I grew to trust him after a few visits. He may not be aware of it, but I'll drive the 20 miles from home to drop the car off for the day.

Nonetheless, once the trust has been established and the relationship built, what possible reason is there for him to say "now that you trust me, I have no need whatsoever to allow you to remain confident that I am not gouging you, that I am competitive with my rates, or at least you are only paying a small premium to continue a trusted relationship".

No, in fact, whenever I drop my car off, he calls me before commencing any work. Tells me what parts I'll need, how fast he can get them, how much they'll cost, how much the labour will be. I get a full and detailed price estimate before any work begins.

Of course, I don't have an automobile HMO. If I were as divorced from my car maintenance payments as I am from my medical bills, he might be extremely willing to perform as much work, necessary or otherwise, on my car, and file for reimbursement. But no, he knows full well I have limited means, I want the car to run but not be in tip top as-new condition, I'm about function over form and he has *never* offered to pull the dents out of the car.

I agree whole-heartedly; shopping for a doctor is not about price, it's about a personal relationship. And like any good relationship, I like to review all the costs; spiritual, emtional, ethical and fiscal. Doctors and health care are not above the money. If they were, we'd all be getting free health care and the docs would be in bread lines, but in fact they make an average six-figure salary and many grumble it's not enough, so quit with the line that it's not about the money. We all want to get paid, doctors and mechanics included.

As the US veers into shifting some of the cost burden back where it belongs - the customer - price transparency has to become the norm. Health care is a business much like any other, it's not so special. Sure, it's a calling. So is software development. So is ministering. We all get paid.

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I heard a story this weekend about a doc who offered to perform a muscular biopsy in the office for a nominal fee of roughly a hundred dollars. The patient called in for pre-authorization and the HMO responded that they would only cover it in a hospital. The patient duly made an appointment and received a bill for a couple of thousand dollars, the co-pay on a $20,000 bill.

The doc took it upon himself to call the HMO and call them out for being idiots, although who knows what actuarial rules were at play, but nonetheless, we need more docs like this looking out for both the patient *and* the bottom line; customer service and the price thereof are all part of doing business and private practice docs especially are - am0ng other things - small businessmen just like your local accountant or your local mechanic.

Bring the customers in, perform a good, quality service and charge a competitive rate. That's all we ask.

I can't speak to the accuracy of the numbers above, but this and similar events occur all the time, part of a system where the money is so divorced from the consumer it's like trying to dig up information on the Illuminati.

So, in short, I applaud the California doctors and I eagerly await news of more like-minded practices.

And if you have a crazy hospital bill story to share, please do.

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One final note, more of a note to self really.

Why do doctor's customers get called "patients"? I'm not his patient. Maybe if I'm in a hospital and I have to stay there then maybe I'm a patient, but a doctor I see maybe once a year? The only patient-ness I exhibit is the two hours waiting until 3pm for my 1pm appointment. Stop calling me a patient. Other professionals call me a client. Anyone else agree?
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Finally, Someone Gets It

Project To Merge Health Care, Banking Information Systems

The Tennessee-based Medical Banking Project later this year plans to unveil a computer-based platform that would allow banks to share medical record information and offer standards to manage that process, the Tennessean reports.‎ Full story...

Bill More, Bill Less

Yanked this out of kaisernetwork.org today...

Hospitals Bill Uninsured Patients More

Hospitals on average bill uninsured patients 2.5 times more than they bill health insurers and three times more than they bill Medicare for medical services, according to a study published on Tuesday in the journal Health Affairs, the Los Angeles Times reports.

Wisconsin Hospital Association Recommends Guidelines

The Wisconsin Hospital Association has released new recommendations that hospitals provide uninsured patients with discounts similar to those negotiated by health plans for insured patients, the AP/Chicago Tribune reports.

‎ Full story...

50,000 Clinical Trials Go Public

GENEVA (Reuters) - The World Health Organization (WHO) said on Friday it was improving access online to data on clinical trials in the wake of high-profile cases of drugs being tested with possibly harmful side-effects.



A new Web site aims to help researchers, doctors and patients obtain reliable information on high-quality clinical trials, it said in a statement.

Currently a "significant proportion" of trial research is never published, meaning doctors can lack information about treatment options, according to the United Nations agency.

Initially, data from 50,000 clinical trials provided by three registers -- in Britain, Australia/New Zealand and the United States -- have been put on the WHO site, which is www.who.int/trialsearch.‎ Full story...

Health Courts

What if we could have a rational, consistent medical justice system that resolved claims expeditiously? What if the bulk of the money spent on the system went to victims instead of to legal fees, court costs and other expenses? Finally, what if this new system could actually promote patient safety by bringing the causes of medical injuries to light rather than pushing that information underground?

These are the questions being asked over at RWJF's Pioneer portfolio blog.

‎ Full story...

Movement to improve quality of children's healthcare

Martina blogs: The Children's Healthcare Quality Act (S.1226), a bipartisan bill introduced in the Senate this week, is a first step in eliminating the disparity between adults and children when it comes to measuring and reporting on health care quality. The bill would provide federal authority and $100 million over five years to invest in the development and testing of quality measures for children’s health care. In addition to providing support for private sector’s development of pediatric quality measure development, the bill would make it possible for the Centers for Medicare and Medicaid Services (CMS) to fund demonstrations of evidence-based approaches to improve hospital care for children.

Pediatric measures are especially lacking when it comes to inpatient care, according to a nationwide survey by the National Association of Children's Hospitals. Last year, N.A.C.H. commissioned a 50-state survey by Health Management Associates. It found that while states use quality measures for children’s health services, they are almost always measures of primary and preventive care for children enrolled in managed care plans, not inpatient hospital care for children. Only two states indicated use of any pediatric inpatient measures. Because of limited resources, states are looking to the federal government for leadership and measures.

Read more:

• Analysis: Measuring quality like grownups, United Press International (04/27)
• Nation’s Children’s Hospitals Endorse Senate Bill to Address Need for Quality and Performance Measures for Children’s Health Care, National Association of children's Hospitals and Related Institutions (04/26)

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