For decades, it has been clear that the clinical trial, as important as it is, is not the only way to prove that a particular approach works. As Jeanne Lenzer and Shannon Brownlee described this past weekend, many interventions are in use that have relatively little data supporting their efficacy.
The carnage associated with this institutional sloth has been horrific. Responding to a new report showing that hospital care has not gotten significantly safer in the decade since an Institute of Medicine study raised the last alarm about quality, Michael Millenson just revisited this scandal of silence within the medical community in a powerfully sobering piece, here. (It’s also worth rereading Michael’s devastating 2003 Health Affairs piece, The Silence.)
The other, obvious, more powerful way to zero in on what works best is to bring together and analyze the vast quantities of data generated by health care encounters, claims, prescriptions, telemetered monitoring, and on and on. (For those who missed it, see Carl Taylor’s great essay on the inadequacy of our current infrastructure to deal with or make sense of the torrent of new kinds of health care data.) But, to date there has been little systematic market-based (as opposed to policy-driven) data collection and analysis to identify which approaches consistently produce the best outcomes at the lowest cost. Many health care firms and professional societies have resisted any transparency, not only because it might expose excess and reduce their revenues, but because they worry it would give away competitive information. (More on this in a series on the pros and cons of provider profiling, coming soon.)
Which is why Wednesday’s news – see this WSJ article by Ron Winslow – is so welcome. Six prestigious health systems – Mayo, Cleveland Clinic, Intermountain, Dartmouth-Hitchcock Medical Center, Geisinger Health System and Denver Health – have committed to sharing and analyzing data to zero in on best practice. Together these systems provide care for 10 million patients.
Perhaps the strongest component of the new group’s plan is their interest in participation by other systems. This approach could overcome the jealous guarding of data to protect local market positioning, and precipitate more open data sharing nationally. It would add many more lives to the data base, facilitating much finer granularity in the results, and giving us an increasingly more nuanced understanding of how care finds expression around the country.
This is a huge, much needed and long overdue step forward. Kudos to this new effort’s founding systems and their vision. Their success is in all our interests.