Making Clinical Outcomes Public: For Providers, the Train Has Already Left the Station

Nov. 4, 2013
A recent retrospective study of hospitalized children with a sepsis diagnosis speaks to the urgency with which CIOs and especially CMIOs need to compel forward an ongoing dialogue with their organizations’ physicians around accountability for and transparency over clinical outcomes, in today’s fast-evolving environment.

It was very enlightening to read the results of a recent study conducted by Michelle Schimelpfenig, D.O., Jean M. Kelchen, M.D., Jacqueline Berner, M.D., and Benson Hsu, M.D., of the Sanford School of Medicine at the University of South Dakota (Sioux Falls). Dr. Schimelpfenig and her colleagues presented in a session at the American Academy of Pediatrics national conference, held in Orlando Oct. 26-29, based on a retrospective study they had performed of hospitalized children with the diagnosis of sepsis, using data from the Agency for Healthcare Research and Quality (AHRQ) 2009 Kids’ Inpatient Database (KID). The data set consisted of 7.37 million weighted discharges, across 4,121 hospitals, in over 44 states. Diagnosis of sepsis was based on all patient refined diagnosis-related groups (APR-DRGs) of septicemia and disseminated infections.

And here’s what they found: “There were 11,893 patients discharged with an APR-DRG of 720, 5,085 in non-te4aching hospitals and 6,808 in teaching hospitals. In comparing non-teaching versus teaching hospitals,” the authors noted some perhaps-surprising results. Among them: “When examining the highest severity of illness class… those in non-teaching hospitals had a mortality rate of 12.50 percent versus 14.01 percent, average length of stay of 10.91 versus 14.19 days, average number of procedures of 3.31 versus 4.30, and average total hospitalization charges of $113,384 versus $143,999.”

The authors’ conclusion? “Our study demonstrated that teaching hospitals, in caring for pediatric inpatients diagnosed with sepsis, had overall higher charges, length of stay, procedures performed, and morality rates.” Indeed, they add, “Even when accounting for a higher level of severity, these trends mostly remain. Our findings,” they note, “were contrary to previous studies attributing higher costs and resource utilization in teaching hospitals but having similar clinical outcomes. Thus,” they write, “our study suggested that teaching hospitals, when compared to non-teaching hospitals, provide care for sepsis at greater costs and resources without an improvement in mortality rates.”

There are several important takeaways from this study, but I’ll focus primarily on one or two here, having to do with transparency, accountability, and data in the new healthcare. As more and more data becomes available and becomes usable and shareable, there is absolutely no question that hospitals and physicians will be under increasing pressure to justify their costs and charges in a healthcare system that is reworking itself to become more transparent and accountable, under pressure from the purchasers and payers of healthcare. Indeed, what struck me the very most about the results of this study, and about the authors’ conclusions, was this: in the “old” healthcare—including the vast swaths of the U.S. healthcare system that remain outside the realm of very regular, widespread measurement and accountability for detailed clinical outcomes in specific areas—there remains ample room for the marketing of facility and provider entity, meaning, “Come to Famous Academic Medical Center because we’re famous!” Whereas, in the new healthcare—the healthcare system that is emerging, with objective data being shared very widely about clinical outcomes elements that are becoming ever-more-precise and ever-more-meaningful, the “Come to Famous Academic Medical Center” marketing campaigns will begin to have less and less impact over time.

What’s more, as the consumers, purchasers, and payers of healthcare find out in increasing detail about the specific outcomes in teaching and community hospitals, they will be able to drill down to a level far granular than that of labels and reputation. And over time, inevitably, that process will force a level of transparency and accountability that does not yet exist in the system.

For healthcare IT leaders, particularly CIOs, and most particularly CMIOs, this means an ongoing conversation, discussion, dialogue, with clinicians, especially physicians, about what all of this means. It will necessarily be an iterative discussion, but getting the front-line doctors on the same page with everyone else, about this, will be absolutely essential; because the days of relying on reputation and image are quickly fading. And this study is just one example of the direction in which everything’s heading. The bottom line? The train has already left the station: have you got all your passengers on board??

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