I just attended a session on how a medical center can improve its health care performance statistics. The session didn’t cover a single aspect of how to reduce infection rates, lower death rates, avoid wrong site surgery or anything like that. The whole session was devoted to how to change how comorbidities are reported.
Here’s the thing: to evaluate the quality of health systems, things like death rates are reported. But those death rates depend on how sick the patients are. A system that takes care of sicker patients will have more patients die. So when comparing quality measures like death rates across different hospital systems, it’s important to know how sick the overall patient mix is.
At this event, the speaker described how just changing how doctors document the various problems the patient has can dramatically change the score for illness severity, thereby changing the severity of patient mix, and ultimately changing the system’s overall score for quality compared to other hospitals. I guess one way to look at this is that more accurate reporting will give more accurate quality results to compare one health system against others. Another way to look at it is that it is just more attention on “how to play the game” rather than focusing on how to really improve quality.