We need to get used to public scrutiny and analysis of outcomes ("Variations on a theme," Oct. 11, p. 6). Unfortunately too often we try to explain the data rather than understanding the data and making the necessary changes in our systems.
Do you have information where I can see the original study data? I would be interested in calculating the results for our facility to see where we fit into this evaluation.
As an organization we know we have a great opportunity to improve-but it will take a collaborative effort with medical staff and hospital operations to succeed. What we need is a cultural shift from independent practice to a collaborative, proactive system using evidence-based practices. Many of those studies are two to three years out of date.
Director of quality management
Enloe Medical Center
Editor's note: For more information go to healthaffairs.org. Health Affairs published a package of seven studies titled "Variations revisited" on its Web site.
... while looking at the variables
I read your cover story on whether greater amounts of care result in better outcomes.
As a senior physician executive with a lifelong interest in quality-control measures and analyses of variance, it is a tough sell to conclude meaningful opportunities for improvement from a claims database without at least adjusting for sociodemographic variables of the subpopulations being served.
Poor people, people without transportation, elderly who live alone without family support structures, illiterate populations and folks who don't speak English all appear to consume larger amounts of healthcare services once they suffer an episode of illness.
Chief medical officer
Sinai Health System
Next, fix the system
I read with interest the article on the shortage of influenza vaccine ("When doses disappear," Oct. 18, p. 16). I, too, was offered the opportunity to purchase the vaccine at a greatly inflated price. I appreciate that HHS Secretary Tommy Thompson is interested in prosecuting companies that find a way to obtain flu vaccine and sell it at a significant profit. I must ask, "What took you so long?"
These companies have been around for quite a while, and no one has taken national interest until now. If a hurricane hits a part of our nation's coast, vendors are prosecuted if they profit handsomely on the misfortunes of others. However, the same thing happens on a daily basis in our hospital pharmacies.
I would like the purveyors of over-priced items in short supply to go away. Better yet, I would like us to fix the broken system that created these shortages in the first place.
F. Daniel Hurd
Director of pharmaceutical services