A maxim of the business world goes like this: You can't manage it if you can't measure it. It's as true in medicine as in any other industry. Yet the entire care-giving industry operates without broad access to the kind of routine data that would be basic in other industries.
And it suggests that the phrase "managed care" is, strictly speaking, an oxymoron.
Individual hospitals may measure rates of infection, relapse and mortality, for example, but others may not, or may measure them in different ways in different parts of the country, said Bruce Boissonnault, executive director of the Niagara Health Quality Coalition. While hospitals may not be operating blindly as a result, they are nearsighted in the extreme.
The result is a mishmash of statistics that makes it hard for hospitals to compare their practices and make valuable improvements. Just as bad, the unclear and insufficient data make it nearly impossible for the public to make informed choices about health care -- choices that run the gamut from where to go for heart surgery to how to interpret proposals to build new hospitals or close existing ones, an urgent matter in Western New York.
This issue is becoming more crucial as hospitals founder in red ink. Hospitals that don't meet competitive standards of care may soon find themselves sinking deeper as insurance companies threaten to send their clients to better-performing hospitals, and Internet-savvy patients become more sophisticated about assessing their care.
One of the bright spots about Western New York medical care, in fact, is that patients here have access to a database of information. Boissonnault's organization is one of the few in the country that provides information about patient experiences.
The project, which is to be updated in April, has come in for criticism from the health care industry, and even Boissonnault acknowledges imperfections. But if health care is to improve, the public needs to help drive it. Hospitals, doctors and insurance companies can do a lot, but pressure from informed customers is the surest way to get the attention of hospital administrators who are distracted by a dozen other competing issues.
Whatever criticisms may be leveled at the Health Quality Coalition, it is giving the public better information than it had. The way to assess its performance is not whether it provides an ideal mechanism for measuring the quality of care, but whether anyone else is providing better information and whether the coalition continues to improve its own performance.
Some other sources are also available. A hospital profiling project undertaken by Ford, General Motors and the United Auto Workers, with assistance from the coalition, is available through the coalition Web site. The Western New York Healthcare Association denounced the report last year, but praised the updated version released this month.
A joint project by the New York Public Interest Research Group and Center for Medical Consumers provides raw data -- that is, not adjusted for population or other factors -- on the number of times New York doctors and hospitals perform more than three dozen common surgeries.
The state Health Department provides comparative information about heart surgery and other subjects, and Gov. George E. Pataki last year approved legislation that will give New Yorkers easier access to information about doctor malpractice and discipline. But progress is slow. A year ago, under pressure, he and the Legislature killed a plan to create a system of hospital report cards in New York.
But medical data is only part of what the public requires. It also needs to comprehend, at least in some rough way, the finances of health care. It needs a source of data that will connect the dots that represent over-capacity, financial stress and second-rate service.
As useful as these sources may prove to be, what is really needed are national standards and a single source of information -- a clearinghouse that will allow doctors and hospitals to measure their performance against their peers and will give patients the data they need to make informed decisions about their care. A national approach, perhaps based out of the U.S. Department of Health and Human Services, would allow Web-based comparisons among states.
In the meantime, Western New Yorkers can explore the Web sites of organizations such as the Quality Coalition, the Center for Medical Consumers and the state Health Department. Those sites provide enough information for consumers to ask the kind of questions that can improve not just their own care, but can drive improvements in hospital care, in general.
Here are some Web sites that can help medical consumers make informed choices about their care:
www.myhealthfinder.com -- The Niagara Health Quality Commission includes rankings based on the experiences of Western New York patients as well as information about hospitals, doctors and insurers. It includes links to other reports, as well, including the hospital profiling project by Ford, General Motors and the United Auto Workers.
www.health.state.ny.us -- The New York State Health Department posts data on coronary artery bypass results, professional misconduct, physician discipline and other subjects. Go to the Web site and click on "Info for Consumers."
www.medicalconsumers.org -- The Center for Medical Consumers provides news about consumer health issues as well as the report on surgeries created with the New York Public Interest Research Group. Click on "Procedure Volumes" at the top of the page, but be sure to understand the limitations of the data, as presented on the Web site.
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