One Problem with Healthcare Data
This article caught my eye recently: “Canada leads in surgical mishaps.” By “leads,” the article means they have a high number of mishaps (which is really more of a trailing position, not a leading one). I'm not here to quibble about language, nor am I here to bash Canada's healthcare system because I would suspect our healthcare delivery systems (including the way operating rooms function) are more similar than different between the U.S. and Canada, which would likely lead to similar results, you might think.
From the article:
If you are scheduled for an operation, take note: Canada has the third-highest incidence of “foreign bodies” being left inside patients after surgeons sew them up, one of the poor performances noted in a report comparing health-care systems in developed countries.
Looking at another piece of data:
Canada was in the top spot for the number of accidental punctures or lacerations during surgery out of the 17 countries surveyed by the Organization for Economic Co-operation & Development (OECD).
At 525 per 100,000 hospitalizations, its rate was more than three times as high as Britain (174) and the U.S. (166).
OK, so being three times worse than Britain or the U.S. seems like it might be a statistically meaningful difference? So what the heck is going on up there?
Again, from the article:
Ms. Tipper also said the reason Canada may seem to have more mistakes could be in the accuracy of its reporting.
Hmmm…. we know that the underreporting of medical errors is a major problem. It might be easier to avoid reporting an accidental puncture (where the harm to the patient might be chalked up to “complications”), while an item left inside the patient is more cut and dry, right? Could other countries really have such significantly lower error rates solely due to undereporting? I find it hard to believe that Canada could be 3x more dangerous, even in one area like this.
Canada is working to improve their healthcare quality culture, as we are in other countries:
Dr. Simpson, who has been working as a cardiologist for 20 years, said “the culture of safety is undergoing a renaissance in Canada, right now. When I first started, mistakes were something to be ashamed of, and you didn't talk about it. But now, it's completely flipped around.”
Being ashamed of a process problem or human error leads people to hide and cover up their problems. This gets in the way of the improvement needed to prevent future systemic errors.
On the topic of “gaming the numbers” or skewing data (instead of actually improving the system), it's widely reported that the United States has abysmal infant mortality results (USA Today editorial: “No excuse for U.S. infant mortality ranking“).
Twenty years ago, the United States was doing better than countries such as Cuba, Poland and Estonia in keeping newborn babies alive. Not any more. As other nations improved this key indicator of women's and infants' health, the U.S. lagged, dropping to 41st worldwide in newborn death rates, behind these three countries and 37 more.
Some argue that the U.S. ranks low because we are actually honest in how we report infant deaths after birth, while other countries might skew the data. From this opposing USA Today editorial (“Another view: Misleading neonatal data distort rankings“):
First, the U.S. strictly adheres to the World Health Organization's definition of live birth (any that “breathes or shows any other evidence of life”), counting even the extremely premature and most fragile. In contrast, theWHO Bulletin noted the “common practice in several (Western European) countries to register as live births only those infants who survived for a specified period.”
Can we have meaningful comparisons and improvement without accurate, trustworthy data?
Bringing this back to more local healthcare decisions, how can you or I choose a surgeon or a hospital based on quality and cost (value) without widely-available and trustworthy data? What are your thoughts on this? Leave a comment…
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