. . . If I Only Had a Brain

Hip replacement devices go bad. Europeans and Australians know it long before Americans. Why? They have a electronic registry that tracks performance, according to today's New York Times.

But why limit this story to joint replacements? Why not all medical devices. Hey, while we're on the subject, why not adverse events from drugs? Or all off-label uses of drugs so we can track their performance? Heck, why don't we track performance of on-label uses to see if there is huge discrepancies between the results of the small clinical trials that led to Food and Drug Administration approval and the product's widespread use in the general population?

Isn't this really a story about electronic medical records and public reporting, and how America, despite spending nearly twice as much on average as other advanced industrial nations on health care, lags behind on these measures of performance, just as it does on life expectancy, infant mortality, and unnecessary medical errors? As a Commonwealth Fund Report Card pointed out last week:

The U.S. now ranks last out of 19 countries on a measure of mortality amenable to medical care, falling from 15th as other countries raised the bar on performance. Up to 101,000 fewer people would die prematurely if the U.S. could achieve leading, benchmark country rates.

But not everything on the report card was grim:

The exception to this overall trend occurred for quality metrics that have been the focus of national campaigns or public reporting. For example, a key patient safety measure—hospital standardized mortality ratios (HSMRs)—improved by 19 percent from 2000–2002 to 2004–2006. This sustained improvement followed widespread availability of risk-adjusted measures coupled with several high-profile local and national programs to improve hospital safety and reduce mortality. Hospitals are showing measurable improvement on basic treatment guidelines for which data are collected and reported nationally on federal Web sites. Rates of control of two common chronic conditions, diabetes and high blood pressure, have also improved significantly. These measures are publicly reported by health plans, and physician groups are increasingly rewarded for results in improving treatment of these conditions.

In other words, keeping close track of data, publishing the results, and rewarding physicians for improved performance works.