Who needs to know? Balancing quality and privacy in health care

Today’s post comes to us from Professor Niek Klazinga, Professor of Social Medicine  at the Academic Medical Center of the University of Amsterdam and contributor to the Health Care Quality Indicator Project, OECD Health Division

... but sharing data can save them

Quality has become a buzzword in health care, as in so many other sectors. Industrialized countries are shifting gradually from governance based on cost-control towards models that also take the quality of the health outcome and process into account.  

This makes sense for many reasons. Judging the “success” of health interventions – whether or not they meet certain quality objectives – is important to any decision on how health care dollars should be spent.  A whole new information industry has sprung up  to produce performance information for governments, patients, health care financers, managers and professionals alike, by measuring different aspects of quality.

Data about quality is needed if we are to improve systems, but collecting it can be controversial since it means keeping track of some aspects of health delivery that we used to consider “private”. The debate around the need to collect data versus the need to protect privacy is only starting.

For good comparisons on surgical complications, for example, we need to know whether the complaint existed at admission  (admission codes indicate this), whether the patient had diabetes or asthma (secondary diagnoses) or whether the patient has also been to another hospital or primary care physician with the same complaint (data linkage via unique patient identifiers).

Gathering this kind of information to improve quality in health care seems justifiable and not  the type of privacy invasion that data protection rules were originally designed for.  Yet the critical attitude towards government and overall concern about privacy currently limit the production of reliable and comparable information on quality and safety.

It is hoped that during the upcoming OECD ministerial conference, countries where these debates are farther along can be inspire those still in the middle of it seeking a balance between the quest for better comparative information and privacy concerns.

Useful links

The OECD Health Care Quality Indicator Project was launched in 2002 to produce reliable, valid and comparable information on the quality of health care in member states.

Results were published in Health at a Glance in 2007 and 2009, covering cancer care, care delivered for cardiovascular diseases, primary care, mental health care and care related to infectious diseases among others.

A working paper on patient safety indicators was published in November 2009.

This won’t hurt a bit…

And remember to clean your teeth with sugar

This week the Insights blog will be focusing on health care issues. In this second post, we introduce evidence-based care.

My grandmother believed that tar fumes stopped kids catching colds, so if she saw road menders at work, she’d march me, my sisters and brothers and our friends over to breathe in the vapours.

We’d then have to huddle around a steaming dollop of bitumen, arms flapping to help the lungs pump the goodness into our ventricles, like a flock of baby seagulls stuck in an oil slick.

A woman who thought that pigs could see the wind probably wasn’t the best source of advice on health (or anything else), and a carcinogenic mixture of 10,000 chemicals, half of them unidentified, probably not the best prophylactic around, but the wisdom of the ancients is not the only knowledge that seems bonkers in retrospect. Mainstream medicine has had its share of dubious treatments too.

Not just dubious. The aptly named To Err is Human report from the US Institute of Medicine in 2000 estimated that medical errors killed more people than traffic accidents in the US.

Of course, with millions going to see the doctor every day, even a tiny fraction of mistakes soon adds up to a startling sum, but the problem isn’t just a slip of the scalpel or an illegible prescription. Another report estimated that up to a third of treatments had no real clinical effectiveness.

To the layperson, this is astonishing. How on Earth were the doctors deciding on treatments? Rolling dice? In fact, they were applying what they’d learned at medical school and best practice as it evolved. (more…)