The ongoing history of quality improvement in medical care in one of great theories and hypotheses which seldom seem to pan out in ultimate health outcomes. A study in the New England Journal of Medicine deals with one such effort. (NEJM Article) A heart attack is typically due to constricted blood flow within the heart. For a victim, getting to a setting where the affected artery can be opened more fully may be critical. Therefore, many quality improvement programs have set a goal of a “door to balloon” time of less than 90 minutes. Pay-for-performance and quality reporting programs frequently use this measure. A large consortium of health systems provided the data used in the study from a registry, with a total of over 95,000 patients examined for the time period 2005-09. Average door-to-balloon time decreased from 83 minutes in 2005-06 to 67 minutes in 2008-09, demonstrating the effect of the quality improvement programs. The in-hospital mortality rate, however, barely budged, from 4.8% to 4.7%, a non-significant change. Over 80% of patients were getting to the hospital in less than 90 minutes, but there mortality was unchanged. Getting to the hospital in less than 90 minutes was clearly associated with lower mortality, but getting more patients there faster did not change overall mortality. It may be that simply getting someone to the hospital faster isn’t the major factor in survival, other circumstances may be more important. In any event, all the effort and money spent on this goal may not be getting the best bang for the buck.
✅ Subscribe via Email
About this Blog
Healthy Skeptic Podcast
Research
MedPAC 2019 Report to Congress
June 18, 2019
Headlines
Tags
Access
ACO
Care Management
Chronic Disease
Comparative Effectiveness
Consumer Directed Health
Consumers
Devices
Disease Management
Drugs
EHRs
Elder Care
End-of-Life Care
FDA
Financings
Genomics
Government
Health Care Costs
Health Care Quality
Health Care Reform
Health Insurance
Health Insurance Exchange
HIT
HomeCare
Hospital
Hospital Readmissions
Legislation
M&A
Malpractice
Meaningful Use
Medicaid
Medical Care
Medicare
Medicare Advantage
Mobile
Pay For Performance
Pharmaceutical
Physicians
Providers
Regulation
Repealing Reform
Telehealth
Telemedicine
Wellness and Prevention
Workplace
Related Posts
Commentary
March 24, 2023
The CDC Is a Font of Methodological and Statistical Error
Several times in the last three years I and others have pointed out serious flaws…
Commentary
March 24, 2023
A Couple of Health Care Notes
A couple of pieces of health care research focus on high health care spending and…
Commentary
March 21, 2023
Minnesota’s New Energy Insanity, Part 7
Minnesota is a particularly poor place to rely on solar power, but other states aren't…