Talking About Medical Quality: Consider the Source

Summary: Measuring quality is a constant challenge in health care: quality of prov

Summary: Measuring quality is a constant challenge in health care: quality of providers, quality of hospitals, quality of drugs, quality of treatments. Much of what’s out there is conflicting or written for professionals. A lot of quality information is actually delivered in the form of marketing materials, written to induce patients and providers to choose a specific treatment. Other quality assessments are affected by more subtle connections: If a nonprofit organization writes a seemingly straightforward report, that’s good, right? But what if that organization is funded by insurers, drug companies, or the American Medical Association? Make sure you know what the source of the information is.

First, we’re frequent users of the Mayo Clinic website. There is a lot of plain-English information there.

Another favorite resource: The American Board of Internal Medicine Foundation has spearheaded the “Choosing Wisely” campaign, talking about best practices in prescribing treatments. The choices to recommend for or against treatments were made by the providers themselves, or by their professional organizations, often in conflict with their economic interests. More testing means more money, but more testing is not always a good idea.

Resources like Dollars for Docs, compiled by the journalists at ProPublica, detail the payments made by Big Pharma to doctors, giving insight into where influence may be being exerted: If your doc is getting paid by a drug company and prescribing a lot of that company’s drugs, how do you feel about it? By the way, ProPublic is an investigative news organization that doesn’t have any financial gain from revealing this information.

Then there are more complex quality assessments.

While doing research for a blog post about the rising price of drugs, I learned of the Institute for Clinical and Economic Review, a Boston nonprofit, which does thoughtful research on treatments. The topic of the $1,000-a-dose Hepatitis C medication Sovaldi, which has been much in the news, was on my mind.

“A panel of experts at a recent forum in San Francisco concluded that the drug offered ‘low value’ for treating most patients, in large part because of its high price,” The New York Times wrote in an editorial. “That judgment was based partly on an assessment of clinical and cost-effectiveness prepared by a nonprofit organization that evaluates medical treatments (the Boston-based Institute for Clinical and Economic Review). The group estimated that replacing current care of infected Californians with Sovaldi-based regimens would raise drug expenditures in the state by $18 billion or more in a single year. It said projected savings from reduced medical costs in later years would not come close to offsetting that cost.”

In the debate over expensive medications and treatments, the source of the information should be considered. Julie Appleby of Kaiser Health News wrote a wise piece about this detailing recommendations: If the group recommending for the drug has close ties with the drug industry, then shouldn’t its conclusions be suspect? If the group recommending against the drug is from the insurance industry, which is allergic to paying high prices for just about anything, shouldn’t its conclusions be suspect? If the group is doctors, do they have ties to Big Pharma?

Appleby’s story pointed out that the Institute for Clinical and Economic Review has close ties to the insurance industry. Many of its advisors and board members and funders are from the industry, so that might lead us to assess the recommendations with a careful eye.

Still, some of its resources may be useful.

For example, if you were thinking of treatment for sleep apnea,
This guide to treatments is thorough and may help understand the landscape.

A similar guide for treatment of ADHD disorders, and one for prostate cancer treatment, discuss options.

The site’s resource page has a number of links to other quality and assessment sites.

In short: you should always consider the source of the assessment.

Who’s paying for it? What are their interests? Know that, and you can judge the information better.