Supersized Quality


The Agency for Healthcare Research and Quality (AHRQ) just released its 2015 National Healthcare Quality and Disparities Report and it is a very qualified report about quality.  Don’t let the title fool you because this report addresses:

The progress made against the National Quality Strategy (NQS) priorities at the 5-year anniversary of the Strategy. The NQS is backed by the National Healthcare Quality and Disparities Report data. Integration of these two efforts within AHRQ supports the development of this more comprehensive report on the success of efforts to achieve better health and health care and reduce disparities.

Got it? No?  C’mon, it’s easy:

Quality measures are compared to achievable benchmarks derived from the top-performing states. A bar graph categorizes and ranks 178 measures into three categories — far from the benchmark, close to the benchmark or achieved/surpassed the benchmark.

Still don’t get it? What they are trying to say is that it is measuring the “quality of health care provided to its population”.  The problem is, as I have pointed out a million times on this blog, is that the word quality is tossed around so egregiously that it cannot be defined anymore.  For example, according the report, here is the list of top performers:

  1. Maine (65.47 percent)
  2. Massachusetts (64.95 percent)
  3. Wisconsin (63.54 percent)
  4. New Hampshire (62.91 percent)
  5. Minnesota (61.54 percent)
  6. Iowa (57.65 percent)
  7. Delaware (57.23 percent)
  8. Vermont (57.14 percent)
  9. North Dakota (57.1 percent)
  10. Rhode Island (55.88 percent)

So, if these states give the best quality of healthcare to its population then they must be the healthiest states. Just for shits and giggles I decided to look at the healthiest states per America’s Health Rankings by United Health Foundation and saw what they found for each of the states above.  Here you go:

  1. Maine – 15
  2. Massachusetts – 3
  3. Wisconsin  – 24
  4. New Hampshire – 5
  5. Minnesota – 4
  6. Iowa -22
  7. Delaware – 32
  8. Vermont – 2
  9. North Dakota -12
  10. Rhode Island -14

Not exactly a match.  But you may say they are measuring different things and I would say yes.  That is my point. When you give bean counters and administers all this credit for coming up with new reports and grades then that is all they care about.  Whether it means anything is irrelevant.

So which one is the real “quality” report?  The answer is neither and both.  Quality is in the eye of the beholder, researcher, doctor and patient and the term has now come to mean NOTHING.


Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  1 comment for “Supersized Quality

  1. September 10, 2016 at 9:39 am

    “Quality” means some number produced by an algorithm that takes many inputs and produces one output. The more inputs it takes, the more sophisticated it appears to be. Using information technology, thousands of “inputs” can be taken, verified and prioritized, coordinated and weighed. “Quality” now only means that an algorithm is used to produce a number.
    It is a fundamental tenet in mathematics that algorithms cannot create new information. They simply cannot. What they can do is take some information that is unintelligible to the scrutiny of a human mind, and lay it out in a form more appealing to a human mind. Whether or not it adds information still is solely the province of the human mind, technogeeks aside.
    Great experimentation has taken place in the financial markets – the stock markets and such. Technical analysis can gather patterns, but it still takes the human mind to discriminate between reality and rubbish. The habit of the mind to find order out of random facts that are unconnected, is called PAREDOLIA. The phenomenon of the worship of paredolia has, to my understanding, never been named – it is universal.
    An infinite number of algorithms, all soundly based, can be generated to predict the price of a certain stock in tomorrow’s market. One can test and analyze them carefully; one can spend years preparing from one transaction. But on that break-the-bank day, what are the odds of the stock going up, rather than down? 50%
    There is such thing as objective QUALITY, but it does not come cheap.

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