The scientific method?
Look for this interesting article in the upcoming weekend’s New York Times Magazine. The article looks at the progress of evidence-based medicine, the attempt to minimize variation in care, and specifically at Dr. Brent James from Intermountain Healthcare in Utah and Idaho. Here’s an excerpt (citing Dr. John Wennberg of the Dartmouth Atlas):
Wennberg, the Dartmouth researcher, argues that Intermountain is fundamentally different from other oft-cited models of high-quality, lower-cost care, like the Mayo Clinic and the Cleveland Clinic. These places, including Intermountain, share certain traits, like having a large number of doctors who receive fixed salaries rather than being paid piecemeal for each treatment. Partly as a result, these hospitals do fewer tests, treatments and operations than other hospitals and still get excellent results. What sets Intermountain apart, Wennberg says, is that it is also making a rigorous effort to analyze and improve bedside care.
“It’s the best model in the country of how you can actually change health care,” Wennberg told me. I heard nearly the same argument from Anthony Staines, a health scholar and hospital regulator in Switzerland who recently completed a study of some of the world’s most-admired hospitals. “Intermountain was really the only system where there was evidence of improvement in a majority of departments,” Staines said.
While Intermountain offers an example of the scentific method coming to bear in healthcare, there are many other instances without such a focus on evidence. For example, the value proposition that has motivated the move toward electronic health care is not necessarily rooted in the same scientific rigor. We’ve talked before about big reform claims that never amounted anything…and specifically touched on how wellness initiatives do not always equate to promised savings. How will the health IT gold rush turn out? Are we on the cusp of change, as this new Robert Wood Johnson Report indicates? Or is the EHR buzz just a case of providers “kicking the tires” on these systems?
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