Thursday, February 11, 2016

Standardization of American Health Care: The View from Boston

Michael Porter, PhD, MBA, of Harvard Business School, Stefan Larsson, MD, PhD, of the Boston Consulting Group. And Thomas Lee, MD of the Harvard Business School, all in Boston,  writing in the New England Journal of Medicine,  also in Boston,  proclaim  in the Journal,  that “The arc of history is increasingly clear  health care shifting from the volume of services delivered to the value created for patients, with “value” defined as the outcome achieved relative to costs, (“Standardizing Patient Outcomes Measurement,” NEJM,  February 11, 2015­.

The authors assure us that “..the feasibility of outcomes measurement is now clear, and broad adoption of the standard sets is beginning.”   They have a table showing that for standard sets of measurements have already been achieved 10 conditions in 2013,  7 more were completed in 2015,  8  done in 2014 await final approval , and 15 are under consideration for 2016 and beyond,  which together will cover about 45% if disease burdens in the U.S. and other advanced countries.

The authors complain that previous work on standardization has been slowed  “dramatically” by different approaches by various organizations, by teaks of existing measures and risk factors, and by sensitivities to physicians concerns.

I am aware Boston is full of advocates for measuring outcomes through use of EHR data and  that it  runs to brains behind the Obamacare  to standardize care,  and somehow, given enough data on mortality, and patient-reported and clinician reported health status,  that  it can  standardize  and systematize care for all patients and all physicians so that one-size-fits- all treatments can be achieved across the population and so that one can achieve the maximum outcomes for the minimal cost.

“Universal measurement and reporting of outcomes won’t happen  overnight,” say the Bostonians, “ But we believe that agreeing upon and implementing respected standard sets of outcome for each medical condition is a practical and decisive step in accelerating value improvement in health care.”

Put me down as dubious.  Information technologies have their limits, and that,  I believe, is the situation  here.   Human beings and their illnesses are too variable  to be reduced to optimal standardized outcomes.


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