Guest Post from Deborah L. Benzil, MD, FACS, FAANS
Member, AANS Board of Directors
Chair, AANS/CNS Communications and Public Relations Committee
Columbia University Medical Center
Mt Kisco, New York
In 1936, the Consumer Union Reports (now published as Consumer Reports) issued their first ratings on milk, breakfast cereals, soap and stockings. Since then, their method for scientifically testing and then rating a wide range of consumer products has become increasingly refined, grown expansively (over 150,000 products tested) and reached an ever expanding audience. The value of their reports is significant and most of us have used them when purchasing washing machines, TVs, automobiles and similar products.
Unfortunately, attempts to apply a similar process to medical care have been less successful. Many such reports use unreliable proxies of performance such as type of medical degree, years in practice, number of cases performed, and unsolicited/non-random “patient” comments rather than true performance, quality measures.
There are significant challenges to attempts to achieving a valid, useful “Consumer Reports” type process for healthcare systems, physicians, and hospitals including:
- Outcomes are less easy to define (think qualitative measures like repair records of appliances versus measuring quality of life outcomes after surgical intervention)
- Lack of homogeneity (while Toyota strives to make each car identical, people are quite diverse)
- Systems within medicine more significantly influence/disrupt patient outcomes than is true of most appliances.
Taking these challenges head-on, the Surgical Quality Alliance has issued an outstanding report, “Surgery and Public Reporting: Recommendations for Issuing Public Reports on Surgical Care.” The scope of the project derives from a strong commitment to optimal patient care as the core value of the medical profession and accountability to every patient, including appropriate and effective therapy, patient safety, cost effectiveness and optimal clinical outcomes.
Crucial highlights contained within the report every neurosurgeon should know are:
- Quality currently defined (mostly by payors) by process measures rather than true performance measures.
- Quality reporting information must be relevant, accurate, and meaningful to the surgical patient without unintended consequences.
- Surgical specialists working with their specialty societies and with quality measurement experts are the most qualified to define meaningful definitions of quality excellence.
- The urgent need to create a culture of collaboration among all stakeholders (patients and providers as well as regulators)
This outstanding report covers a wide spectrum of concepts in a clear and concise manner. The main sections include:
- Basic Operating Tenets of Provider Public Reporting
- General Issues in Reporting
- Audience-Dependent Issues
Consumer Reports for Surgical Care? Yes the time has come, but unless care is taken as eloquently presented in “Surgery and Public Reporting: Recommendations for Issuing Public Reports on Surgical Care” then there is equal chance of doing more harm then good. Buyer, beware!
- AHQR Report “Model Public Report Elements: A Sampler”
- AHQR: Private Feedback Reporting Audiences, Functions and Information Flow Diagram
- NPA/N2QOD: Neurosurgery’s outstanding quality initiative