Healthcare Quality Ratings: Sight Unseen?

Healthcare ratings continue to proliferate. But fewer Americans recall seeing and using them.

Between 2006 and 2008, the percentage of Americans who reported that in the past year they "saw" and "used" comparative health quality information for health insurance plans, hospitals or doctors dropped by 6 percent. (From 20 to 14 percent)

This finding came as part of the Kaiser Family Foundation's 2008 Update on Consumers' Views of Patient Safety and Quality Information. In the same study, the percentage of Americans who said they "saw" that same type of information fell from 36 to 30 percent.

The implications are huge.

As government continues to gather and publish data in the hope of driving efficiency and cost savings through informed free-market forces, fewer citizens are participating. 

As health insurers increasingly generate information to empower consumer-driven healthcare, awareness and use are diminishing. 

As hospitals and health systems seek to differentiate themselves based on quality data, not as many consumers are noticing.

Why are fewer Americans tuning in? 

In 2006, in an article published in Healthcare Marketing Report and in speaking engagements, I warned of factors that would undermine the effectiveness of quality ratings: exploitation and overexposure in marketing, too many sources with no standardization, needless complexity with lack of interpretation, or oversimplification that betrayed the underlying data. The result would be a lack of understanding by consumers, resulting in tune out. It seems to be coming true.

Providing comparative healthcare information and encouraging its use is essential. The two-year downtrend shows that we have lot of work to do. Consumers can't gain insight from comparative healthcare quality information if ratings go sight unseen.

— Tom DeSanto

FDA: Fix Deficient Activity

First, Vioxx faced withdrawal despite FDA approval.

More recently, an impurity in an active ingredient that came from a Chinese factory caused Baxter International to recall its total production of various types of heparin. More than 60 people died from allergic reactions in the aftermath.

In the meantime, the U.S. Supreme Court took the first steps toward removing manufacturer liability when products meet FDA approval. In Riegel vs. Medtronic, it ruled that when the FDA approves the safety of a medical device, individuals have no legal recourse if something goes wrong. A similar case involving pharmaceuticals is due to be heard soon.

Is the FDA up to the task of protecting us? Several statistics depict a dire situation:

   - As of September 30, 12 out of 16 of the advisory committees in the Center for Drug Evaluation & Research were without chairmanship and had 83 vacancies. (Source: The RPM Report)

   - The number of FDA inspectors who certify that manufacturing plants meet current GMP standards has decreased by 25 percent since 2002. (Source: GAO)

   - More than half of the clinical trials used to support FDA approval remain unpublished in peer-reviewed literature for at least five years after approval has been granted. (Source: www.sciencebasedmedicine.org)

Apparently the FDA is deficient in maintaining leadership, staffing and transparency. Many agree it's time for fundamental restructuring.

Representative John Dingel (D-Michigan) is vocal about FDA shortcomings and believes that congressionally mandated change is needed. He is holding oversight committee meetings to take FDA leaders to task about making improvements. Dingel also is formulating an overhaul plan that he hopes to enact by year-end, or that may become a model for action under the new administration.

In a post on this blog on August 8 entitled "Our Healthcare Conundrum," I cited a candid assertion made by the FDA's Dr. Steven Gutman: "The health system will explode in three to four years and that will fix it." As I look at the FDA's current state, I understand his comment as coming from inside the volcano. But, as an optimist, I'm convinced that we can alleviate some pressure from the magma chamber before it blows.

Maybe we really can make progress in retooling the FDA into a organization that facilitates innovation while protecting us from harm. By more clearly defining the FDA's role and responsibilities, establishing strong leadership and accountability, and by providing the required resources, we can fix deficient activity.

— Tom DeSanto 

Disco Redeemed

Who knew? I thought Disco was deadly. Now it has the potential to save lives. 

Researchers at the University of Illinois confirmed that listening to or singing Stayin' Alive by the Bee Gees can help people perform CPR more effectively. At 103 beats per minute, it sets the appropriate tempo for chest compressions.

The American Heart Association recommends a minimum of 100 compressions per minute for CPR. Tuning into Stayin' Alive helped study participants reach 109 to 113 compressions. At that rate, recipients of CPR are more likely to survive.

I guess it's time to dust off my "Disco Sucks" tee shirt and trade it in for one that says "Disco Saves."

— Tom DeSanto

Improving Communication with Patients

The Institute for Healthcare Advancement (IHI) has published a list of the 10 most common errors made when communicating with patients. I've translated the problems into solutions.

10 Best Practices for Communicating with Patients

1. Explain and write instructions at a fifth-grade level.

2. Speak and write in common terms, not medical jargon.

3. Recommend only Internet sites with clear information that supports the physician's advice.

4. Keep font sizes at a minimum of 12 point.

5. Use only simple, literal graphics to support medical instruction.

6. Help patients understand what you say by having them explain it back in their own words.

7. Recognize cultural differences and respond with sensitivity.

8. Talk slowly and allow time for questions.

9. Provide information in the patient's first language.

10. Explain prescription instructions carefully to avoid misinterpretation.

According to the IHI, billions of dollars in unnecessary healthcare expenses can be attributed to misunderstanding between patients and providers. Beyond that, the cost of continued illness from noncompliance — and the frustration and alienation it causes — is immeasurable. 

Taking time to apply 10 common-sense communications practices can make a huge difference.

— Tom DeSanto