Steve Parks, say(s):
February 9, 2009

This is interesting. At the beginning of this discussion you noted that we all want the best for those sick AND INJURED. Could you do the same type of analysis of an area that we have worked hard on for the last two decades - the trauma system? To me it seems that in some regions that have done the effort and made the commitment that the trauma system has been a great success. And in areas where the commitment failed (either economically or by lack of interest) the care is terrible. And in wide regions there are not the resources. How are we doing for trauma care? Does it work where we think it is successful? What is the shortfall?

Scott Hodson, of Maverick Healthcare Consulting, say(s):
February 9, 2009

Many American health systems are significantly underinvested in quality management infrastructure, process, and organization. In order to achieve breakthrough improvements in quality and patient safety, hospitals and health systems need to develop a "world class" quality management foundation that includes:
Strategy: including a clear linkage of quality and patient safety to the organizational strategy and a board-driven imperative to achieve quality goals.
Infrastructure: incorporating effective quality management technology, EMR and physician order entry, evidence-based care development tools and methodologies, and quality performance metrics and monitoring technology that enables "real time" information.
Process: including concurrent intervention, the ability to identify key quality performance "gaps," and performance improvement tools and methodologies to effectively eliminate quality issues.
Organization: providing sufficient number and quality of human resources to deliver quality planning and management leadership, adequate informatics management, effective evidence based care and physician order set development, performance improvement activity, and accreditation planning to stay "survey-ready every day."
Culture: where a passion for quality and patient safety is embedded throughout the delivery system and leaders are incented to achieve aggressive quality improvement goals.

Norman Fine, of American Chemical Society, say(s):
February 9, 2009

Average public health statistics for the USA are skewed by the fact that there are two different populations each with different figures. For example, black infant mortality is twice as great as that for whites. Black male mortality rate is much lower than the white number. If reported as an average the differences are enough to skew the results so that the average is much further down the list of international comparisons than if there were separate reports for each group. I wonder if Scorecard 2008 took these facts into consideration when drawing its conclusions?

Scott Dunn, of Family Health Center, say(s):
February 9, 2009

The most important words, and most difficult challenges, are buried in the summary statement "efficient use of expensive specialized care." Multiple studies show the primary care home is equal or better in quality, with higher patient satisfaction and lower cost. Yet our payment system has created and richly rewarded a highly trained disease focused work force comprising 75 percent of physicians. You get what you pay for. We must pay for what we want.

David Law, of Joy-Southfield Community Development Corporation, say(s):
February 9, 2009

Your valuable report shows that, as a nation, we are continuing to lose ground in health outcomes. Failure to provide universal access to care and to properly prevent/manage chronic disease are bankrupting our health care system (disease care system). Albeit on a small scale, we are making significant progress in promoting health and health care equity for uninsured and underserved west-side Detroit residents. By integrating preventive health education, chronic disease management programs, and client empowerment with quality primary care, we are beginning to see dramatic improvements in health outcomes within a previously underserved population. Prevention is the key. The central problem is that too many people/organizations are making lots of money treating disease rather than preventing it. Reform is urgently needed at every level. The good news is that investing in prevention and management will pay for itself in no time.

The Authors, of Why Not the Best?, say(s):
February 9, 2009

As these readers note, the Scorecard findings underscore the need for comprehensive process and outcomes measurement and improvement across multiple dimensions of care and for multiple populations. We appreciate the importance of a high-performing trauma system to assure the best care is given to those suffering an injury. A recent Institute of Medicine report. called for a more coordinated, regionalized, and accountable emergency care system in the U.S., and for the development of standards by which performance can be measured and reported. The Fund continues to explore ways to highlight disparities among providers with respect to institutional capacity and care delivery.

With regard to disparities, the Equity section of the Scorecard measures health and health care disparities among populations based on race and ethnicity, income, and insurance to assess whether the country is reducing such gaps. (Additional information on specific statistical techniques is available in the methodology section of the report.) We agree that a focus on prevention will be of great importance as the nation seeks to eliminate such disparities and improve population health for all. The experience of the nation's community health centers can provide valuable lessons in showing how the country can better meet the needs of underserved populations.

Scott Hessek, of American Guild for Infant Survival, Inc., say(s):
February 9, 2009

The problem in our overall failing system seems to not to be a medical problem with social outcomes, but rather a SOCIAL problem with medical outcomes. The progressive dumbing-down of our educational system results in a large quasi-medical workforce with an inability to think. This necessitates duplications upon duplications for no one has the ability or authority to make decisions. Government-mandated "unbundling" of services has turned the most routine procedures into 12-step programs. The FDA drug testing/trials system that compares new drugs to placebos rather than against roughly comparable drugs is intentionally senseless; it often results in hugely more expensive drugs which are far, far less effective than the ones they replace...and then the doctors are "bribed" to prescribe them. "Medicine, Inc." is riddled with stupidity, corruption, greed, and a mindset that says, "I may not be able to serve a certain public, but I'll make sure no one else serves them to protect my future potential turf." Opthamologists' lobbyists fight against opticians...MD's fight DO's...physical therapists fight chiropractors. And John Q. Public is left to swelter in the E/R at midnight with a badly infected toenail because he can't get an appointment. So long as we have the "best government that money can buy"(!), our medical system will reflect that sorry state. Sensible, uncorrupted uniform standards is the only way to rein in the system.