A study from the Pennsylvania Patient Safety Authority found that in half of the medication errors in healthcare facilities, the leading factor was the computerized physician order entry (CPOE) function of the EMR and how it interacted with the pharmacy system. A majority (69%) of the errors reached the patient, though few...
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OK, “myth” is a bit of an exaggeration. A study from 2014 by the Robert Graham Center found a U-shaped relationship between medical student debt and the likelihood of students going into family medicine. Actually, it was more of a saucer-shaped curve. Students who had debt > $150,000, but also those with...
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There are some questions in healthcare that can’t be answered with a randomized controlled trial. We can’t randomize babies to inhale secondary tobacco smoke or not to test its health effects. We can’t randomize people to different number of hours sitting the ER before receiving antibiotics after the decision is made...
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I have written about both issues before: freestanding ERs and retail clinics. Two recent studies continue to show how useless they both are in helping create a better more efficient healthcare system. The freestanding ER study  examined the number of these facilities and population characteristics where they locate. They identified 360 freestanding...
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Two recent studies raise doubts about Medicare programs aimed to improve hospital outcomes. One study evaluated voluntary participation in Medicare’s Hospital Readmission Reduction Program, which included 3 “value-based” reforms: meaningful EMR use, bundled care initiatives, and pioneer and shared saving accountable care organization programs. It reported lots of outcomes, and its...
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Hospitalists, doctors who only see patients in the hospital, almost always in a shift work model, are the fastest growing “specialty” in medicine, from nothing about 15 years ago to about 50,000 today. There were some studies that I won’t review much here that showed some benefits from hospitalists compared to...
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First, I recognize that the whole PCMH experiment was not a total failure. There were some successes. The Patient Centered Primary Care Collaborative (PCPCC) puts out an annual review on PCMH demonstration sites that is always positive. On the other hand, the AAFP PCMH National Demonstration Project was mostly a failure....
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Wrapping up my series on our recent paper criticizing how industrial Quality Improvement has been misapplied to primary care, (and sorry for the gap in wrapping this up), I want to share my own thoughts on a way forward. First, in our paper, we proposed very aspirational measurements such as missed days...
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In our recent paper criticizing how industrial Quality Improvement has been misapplied to primary care, we didn’t just complain, we made suggestions for a better way forward. This was under the assumption that regulators and payers will continue to insist on some kind of numeric reporting of outcomes by physicians or...
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In our recent paper criticizing how industrial Quality Improvement has been misapplied to primary care, we didn’t just complain, we made suggestions for a better way forward. This was under the assumption that regulators and payers will continue to insist on some kind of numeric reporting of outcomes by physicians or...
Read More »