Who’s the smartest hospital in the room?

When you shop for a new car, I am sure that you spend a great deal of time researching the available options and going to shops to personally examine the vehicles. The reason you are able to compare cars from different companies with different designs is because of the wealth of information available on every detail of every car. Whether in magazines or online, one can find a tremendous amount of data about every aspect of the new car – its size, its mileage, its rate of needing repairs, its acceleration and so much more.

How do you compare hospitals and doctors? I have discussed before the option of looking at specific subgroups of patients (like young people with appendicitis) and then comparing various healthcare services just on this one diagnosis. You can find a number of diagnoses that lend themselves to such comparisons and as such, you can fairly compare medical care between institutions.

But what if there is comparison for the specific treatment that you need? And who is to say that the Oncology department is better in a hospital that happens to have a higher success rate with appendicitis? Ultimately, how can you get a good broad sense of the quality in one hospital versus another.

Medical guidelines have become a major focus of interest across the entire medical community. No single doctor can read through all of the medical literature and analyze it, to come to the necessary conclusions about which treatment is best. Therefore, each specialty of care has a team of physicians who do in fact review the literature (constantly) and work together to publish a set of standards for the best possible care, according to the most recent research. So, when a patient first presents with high blood pressure, it should not be the personal opinion of the treating physician that guides drug selection, but rather the evidence based guideline that was most recently published by the appropriate medical associations.

With such guidelines, we now have a measuring stick against which to compare the quality of care of individual doctors and entire institutions. Let’s say that we are comparing two group practices of primary care physicians, each with 20 doctors. One practice is in a poorer neighborhood where the patients tend to have more diseases. The second practice is in an affluent area where the average age is lower and the community is healthier overall. How can you compare the quality of care between these two clinics?

Rather than look at absolute drop in BP after starting treatment or longevity of life, what we can now do is compare how well each clinic adheres to the appropriate guidelines. So, if clinic 1 has a 90% adherence rate to the most recent guidelines for managing high BP, but clinic 2 has only a 70% adherence rate, then this is a significant difference. Why would there be such a difference? Great question. It could be that in one clinic, you have older doctors that simply believe their experience is superior to the literature. It could be that one clinic has less experienced doctors who do not even think to follow guidelines. But the fact is that the availability of such guidelines allows a much more absolute means of comparison amongst very different medical services.

A medical service that universally holds to published guidelines is likely to be a professionally superior one. The implication is that such a service cares about quality and standards of care. At the very least, you can say that a clinic with a 90% adherence rate is most often treating patients in the best way medical science knows how. That says alot !!

Such comparisons will drive medical services to compete on the basis of quality of care. The rate of adherence to protocols will eventually be published in the public space so that any and all patients can look at the data before deciding which hospital to go to. EMRs will add features to track and measure adherence to standard guidelines. And once these guidelines have been incorporated into the EMR, they will likely also be used for real time alerts when a physician breaks from the guideline and treats a patient incorrectly (according to the literature).

All of this will benefit the patient. And that’s what medicine is ultimately about.

Thanks for listening