OUTCOMES: INFORMING HEALTH-CARE DECISIONS
William A. See, MD, Professor of Urology, Chairman of Urology
Why is it that a consumer can obtain more performance information regarding an automobile than they can about the surgeon into whose hands they will be placing their lives?
Have you ever stopped to consider how individuals outside of medicine make informed decisions regarding their choice of health-care providers? Imagine that you are a banker who requires excision of a localized renal mass. How would you decide who best to provide that treatment?
Historically, referral to a specialist from a primary care provider, the experience of other patients with the specialist, and professional experience as communicated by the potential surgeon served as the basis for provider selection. Unfortunately, today, many health-care systems are vertically integrated to prevent patient “leakage,” making referral by the primary care physician subject to bias. While other patients may be able to provide insight into the personality of a potential provider, a single data point derived from the management of a problem of unclear relevance to your own— from someone with limited ability to ascertain medical quality—can hardly be considered reassuring. Finally, we have all heard the cynical insider’s interpretation of quotes related to surgeon expertise. “In my personal experience” represents at least one patient. “Time after time” represents a minimum of two. Finally, “in my personal series” implies three or more patients.
By comparison, consider the information available as you contemplate a new car purchase. Government reports, consumer groups and regulated self-reporting by the automobile industry combine to provide a wealth of data to aid the consumer in making an informed decision. From fuel efficiency to crash test ratings, consumers can make value-based decisions driven by standardized, quantitative, objective measures of performance. Why is it that a consumer can obtain more performance information regarding an automobile than they can about the surgeon into whose hands they will be placing their lives? Something is wrong with this system!
This issue of Urology News highlights efforts underway in our department to address this substantial problem. To provide our patients with the information they need to make informed decisions, we have analyzed and are publishing detailed outcomes for a number of key diseases and conditions. Our analysis provides detailed insight into our treatment outcomes going beyond important, but relatively crude measures, such as 30 day mortality. In the case of prostate cancer, our analysis includes duration of the procedure, length of hospitalization, transfusion rate, continence and potency recovery, annual procedural volumes, readmission and major complication rates. Similarly detailed outcome measure analysis and reporting is in progress or planned for nephrectomy, vasovasostomy and cystectomy. Equally important, through our residency educational efforts, we are working to prepare the next generation of health-care providers to understand the importance of quantifying and reporting outcomes.
We believe our efforts toward outcome reporting are critical in aiding health-care consumers in our region in making informed decisions regarding where and by whom their clinical care is provided. To our knowledge, we are the only urology group in Wisconsin currently providing this information. We hope that by engaging in this initiative, others will choose to follow suit. Unfortunately, one of the risks of going public is that other providers and/or systems could claim better results absent formal analysis. Without actual data to support given claims, we encourage health-care consumers to follow the time honored advice of caveat emptor: buyer beware.