http://www.medrants.com/archives/4633 Contemplating medicine and the health care system Mon, 15 Mar 2010 21:13:31 +0000 http://wordpress.org/?v=2.9.2 hourly 1 http://www.medrants.com/archives/4633/comment-page-1#comment-528540 Web Media Daily – Friday July 3, 2009 | Reinventing Yourself... Fri, 03 Jul 2009 13:11:49 +0000 http://www.medrants.com/?p=4633#comment-528540 [...] Deconstructing quality – the nine patients…   DB’s Medical Rants [...] [...] Deconstructing quality – the nine patients…   DB’s Medical Rants [...]

]]> http://www.medrants.com/archives/4633/comment-page-1#comment-528539 Dr.T Fri, 03 Jul 2009 12:53:35 +0000 http://www.medrants.com/?p=4633#comment-528539 Rob, I have been following your thoughts on Quality measurement for some time,and largely agree with you. I am the medical director of a 15 physician hospitalist group in the midwest, and here's my question: Is there perhaps some value in at least a few QI metrics as a surrogate for a larger more robust method of evaluating quality, until such a thing exists? i.e. is there any value in the "if you can't even get THIS right" line of thinking. By way of illustration, my personal bent is that for the vast majority of doctors attitude=quality. That is, those docs who are engaged in their work, care enough to stay current, stop to review a clinical entity they are less familiar with when they encounter it, talk to families, and look for answers to clinical questions instead of passing the buck to someone else or falling back on comfortable old habits; oddly; those are the docs (at least in my group) who DO tend to use IDSA guideline based antibiotics for CAP, who actually make mention of an ejection fraction in the H/P of a HF patient, who consistently provided DVT prophylaxis. Those who blow through rounds, are "too busy" to talk to families, haven't read a journal since residency, etc, they TEND to do poorly on QI metrics as well. I have talked and written a great deal about the shortcomings of quality metrics as they now exist (see my blog or happy's hospitalist with a view) but without an attitudeometer, how else do I approach this? The "quality"of the care you provided the nine is in the time you spent and your engagement of the problems and the patients, I wonder if you would be surprised to know how often that DOESN'T happen in some places. Rob,
I have been following your thoughts on Quality measurement for some time,and largely agree with you. I am the medical director of a 15 physician hospitalist group in the midwest, and here’s my question:
Is there perhaps some value in at least a few QI metrics as a surrogate for a larger more robust method of evaluating quality, until such a thing exists? i.e. is there any value in the “if you can’t even get THIS right” line of thinking.
By way of illustration, my personal bent is that for the vast majority of doctors attitude=quality. That is, those docs who are engaged in their work, care enough to stay current, stop to review a clinical entity they are less familiar with when they encounter it, talk to families, and look for answers to clinical questions instead of passing the buck to someone else or falling back on comfortable old habits; oddly; those are the docs (at least in my group) who DO tend to use IDSA guideline based antibiotics for CAP, who actually make mention of an ejection fraction in the H/P of a HF patient, who consistently provided DVT prophylaxis.
Those who blow through rounds, are “too busy” to talk to families, haven’t read a journal since residency, etc, they TEND to do poorly on QI metrics as well.
I have talked and written a great deal about the shortcomings of quality metrics as they now exist (see my blog or happy’s hospitalist with a view) but without an attitudeometer, how else do I approach this?
The “quality”of the care you provided the nine is in the time you spent and your engagement of the problems and the patients, I wonder if you would be surprised to know how often that DOESN’T happen in some places.

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