Seeing Your Hospital’s Performance How to Get Through the Lies, Damn Lies, and Statistics

June 2016

In biomedical research we often say “if you torture the data long enough, it will confess to anything.” As many in leadership are learning, the complex nature of statistics can be used to obfuscate the truth.  The same is true for the burgeoning list of metrics that have spread across health care.   Some organizations report on well over a hundred different metrics to track their performance.  While these metrics are all intended to reveal important trends in your organization, too many have only a loose correlation with good outcomes.

For the leaders in the hospital C-suite, the question becomes how do you understand your hospital’s true performance?  It is our impression that hospitals have exercised appropriate judgment in supply chain decisions and have a strong grasp of issues of appropriate staffing. It is therefore only a small margin that can be achieved by enhanced efficiency and cost reductions in these areas at most hospitals.  But the clinical pathway itself still offers large opportunities for improvement.   Providing care that results in better patient outcomes will ultimately reduce expenses more than it will reduce revenues.  There aren’t a lot of short cuts here.  Providers just have to provide more cost-effective care.  With that in mind, our research has identified five metrics to use to track your hospital’s performance.

With apologies to Mark Twain, statistical methods can transform “Big Data” into actionable information in healthcare outcomes. MPA Healthcare Solutions has applied sophisticated statistical methods to large databases to identify what the results of care have actually been.  We use risk-adjusted measurements to identify specific areas where outcomes of care can and should be improved.  Using this approach, we have designed predictive models based on hospital performance nationwide.  In the process we have identified five specific risk factors that have a disproportionate impact on patient outcomes.  You can track each for your organization:

1)      Adverse Outcomes Resulting in Inpatient Deaths,
2)      Prolonged Length-Of-Stay (prRLOS) outliers,
3)      90-day post-discharge deaths,
4)      Relevant 90-day post-discharge readmissions
5)      Preliminary research also suggests that “Risk-adjusted 90-day Emergency Department Visits after Discharge” is a key factor.  We are investigating this area further.

We are testing these metrics on the ever-growing number of ambulatory operations as well. Part of our purpose in using these risk factors is not to make any assumptions about why adverse outcomes occurred, but rather to make a no-fault identification of outcomes that were other than what we would prefer to have for patients. This tends to reduce bias and encourage a fair reporting of the data.

With the majority of adverse outcomes not being identified until the post-discharge interval, most hospitals do not know what their risk-adjusted outcomes of care happen to be. Only by knowing your hospital results and comparing them on a risk-adjusted basis, can statistics become a pathway to veracity rather than lies and deception. The patterns of clinical morbidity that are identified in adverse outcomes of care can permit a focused redesign of the elements of care.  That in turn will have a substantial impact on patient and hospital outcomes.

So, statistical processes do not have to be biased and yield perverse interpretations.  Let MPA Healthcare Solutions share with you our published analytic methods for the measurement of outcomes of care. We can identify for you what your hospital results of care are by fully including 90-day post-discharge outcomes. As we have said before, you cannot tell if you are winning or losing the game unless you know the score. Let us help you know the score.

Donald Fry

Donald E. Fry, M.D. is Executive Vice President for Clinical Outcomes Management at MPA Healthcare Solutions, Adjunct Professor of Surgery at Northwestern University, and Professor Emeritus of Surgery at the University of New Mexico School of Medicine. At MPA Healthcare Solutions, Dr. Fry provides clinical leadership in analyzing and evaluating clinical performance, guiding quality improvement, and creating incentives for coordinated, cost-effective care.

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