Entries for June 2007

Yesterday's Web posting by the federal government of information that shows how well individual hospitals deal with heart attacks and heart failure was a big deal—in principle. It was the first dip of the federal toe into a pool of statistics called outcomes data. It means what it sounds like—what happens to people. Whether they live or die.

Previously the federal Centers for Medicare and Medicaid Services, which is running a continuing project called Hospital Compare to give the public a peek at how well hospitals are doing their jobs, had only collected "process measures"—information that shows whether a hospital does the right things, like give aspirin to heart-attack patients as soon as possible. But outcome is what counts.

With a heart attack, speed counts. The guy who shows up at the ER entrance complaining of chest pain very likely dawdled for an hour or two at home before reluctantly letting his wife call 911 (you know who you are), and now the ticking of the clock is more of a countdown. For every half-hour delay in treatment, the odds that the man will be alive a year later worsen by about 7.5 percent. He needs to be rushed to the cath lab for an emergency angioplasty to reopen his blocked coronary arteries.

Oh, great. It turns out that the Food and Drug Administration was far more concerned than it has publicly let on about the heart risks posed by the diabetes drug Avandia. And not just Avandia but Actos, the only other medication on the market that works the way Avandia does to control blood sugar for people with type 2 diabetes.

The Food and Drug Administration wouldn't approve a drug without strong evidence of its safety, would it? No. It wouldn't. And once a drug is approved, the FDA tracks it to make sure, doesn't it? Well, sort of.

We Americans do love report cards, don't we? Where to live, which HDTV to buy, which hot dog tastes best. And experts who think about healthcare policy are hopeful that we'd eagerly snap up report cards on individual doctors, medical groups, hospitals, and nursing homes, shopping for good healthcare the way car buyers inhale Consumer Reports. Providers that didn't measure up would snap to attention or fall out of the picture.