Tonight we were back to PowerPoint at the Mini-Med School, but the lecture was by an MBA. R. Adams Dudley also has an MD, and n 2005 he received the Robert Wood Johnson Foundation's Investigator Award in Health Policy Research.
Dr. Dudley is a pulmonary cardiologist, which is a specialty role. So he offered a different perspective than the primary care physicians who have predominated until now--if I only take away one thing from this lecture series, it will be that America needs more primary care physicians and fewer specialists.
Dr. Dudley didn't address that controversy directly. But he did present extensive research that shows how specialists often rationalize advanced treatments even when they know, intellectually, that more traditional medical care will work just as well. This doesn't mean that the specialists are venial, just that the health care system's incentives and culture facilitate unnecessary interventions. There is extremely solid evidence, which has been presented in some form during every week of this series, that more expensive health care does not lead to better health outcomes.
So the solution--much easier said than done--is to provide appropriate incentives for the outcomes we wish to see. One powerful incentive is public praise or shame. In an example of the kind of reporting Dr. Hal Luft called for last week, Dr. Dudley has been the main force behind CalHospitalCompare, a voluntary rating registry for many California hospitals. This is the public face of the California Hospitals Assessment and Reporting Taskforce (CHART). On this web site people can compare how hospitals in their region are caring for patients for numerous conditions. Detailed instructions on how to use the data are here.
Intuitively, it makes sense that public reporting will cause the workers in health systems to behave differently than they might otherwise. However, I am not sure how to make a tight link between this good idea and changing the psychology of specialists that Dr. Dudley described earlier in his talk. They seemed like two interesting, but separate, presentations.
Final point: Dr. Dudley made a passionate call for much more funding for health services research, which is research into how to improve the overall health system. I first learned about health services research at the NLM, which supports the National Information Center on Health Services Research and Health Care Technology (NICHSR). The acronym never accommodated health care technology anyway, so perhaps NICHSR should tighten its focus to core health services research (well, NICHSR might do this if thought leaders in the field pushed in that direction.) It's the technology--the shiny new toys--that can be seductive in health care, even if they aren't effective.
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