New penalties for hospital readmissions and other poor outcomes are drawing the attention of leading cardiac physicians and researchers to a need for better ways to measure the quality of heart care delivered in the U.S.
“We have a system that has gone out of its way to fail to produce the information needed to make the best choices,” Dr. Robert Califf of Duke University School of Medicine, Durham, N.C., said during a presentation Tuesday at the American Heart Association's 2014 Scientific Sessions in Chicago. In terms of using data in the service of public health, “the U.S. is in trouble,” Califf said, noting astronomical costs of care, decreasing life expectancy and increasing numbers of patients suffering from preventable chronic diseases such as heart disease.
Heart disease causes about 1 in 4 deaths in the U.S., and coronary artery disease alone costs the U.S. about $109 billion a year, according to the Centers for Disease Control and Prevention. “We're losing ground compared to other countries,” Califf said.
Several presenters at the conference said weak metrics in healthcare are undermining the industry's ability to improve. One challenge, they said, is simply understanding whether a given metric actually measures what's intended.
Researchers presented preliminary findings suggesting there's no relationship between how well hospitals performed on process measures for coronary angioplasty—such as prescribing aspirin and statins at discharge, keeping door-to-balloon time under 90 minutes and referring patients to cardiac rehabilitation—and how they did on 30-day mortality outcomes.
Both sets of measures are relevant, but the challenge is to develop new and effective process measures that clearly lead to improvements in patient outcomes, said Dr. Philip Chui of the University of California at Irvine who presented the findings.
“We don't want to burden clinicians with measuring more than a dozen outcome measures if we do not see a clinical impact or outcome from them.”
Some members of the audience in the session suggested that it might take more time to see the benefit of the processes show up in outcomes data. However, consumer groups last week criticized that emphasis on process measures in the assessment of “top performing” hospitals by the Joint Commission, the nation's leading hospital-accreditation body.
Another study presented Tuesday at the meeting explored the relationship between patient satisfaction and outcomes after percutaneous coronary intervention and coronary-artery bypass grafting.
Although 95% of respondents on patient satisfaction surveys at the hospital studied said they were happy with their care at discharge, a follow-up call within 130 days revealed 28% of patients reported feeling depressed or stressed; 21% had difficulty with expenses with hospital bills or medications; and 32% had difficulty keeping up with diet or exercise plans. Only 53% shared any of these concerns with the post-discharge care team.
Hospitals routinely use measures of satisfaction to ensure patients' needs are met, but patients may still have substantial problems not being captured in those reports, said the study's presenter, Matthew Manierre of the University of Delaware in Newark.
“While satisfaction measures may be useful in certain contexts, they may leave things out that eventually drive disparate health outcomes later on,” he said. The inability to pay for medications or to maintain a healthy lifestyle is often sited as socio-economic factors driving high readmission rates.
During his speech Tuesday, Making Good Health Decisions Based on Evidence, Califf stressed the need for well-designed studies to generate the evidence that hospitals and health systems must have to adopt best practices and that consumers need to make good choices.
“This paradigm doesn't work unless we do the right experiments in the first place so that the base of information is correct,” he said. Even if the results are not what was expected, he said, a well-designed trial will always be a success. “It does society a favor by pointing out what doesn't work.”
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