Time to take bolder initiative with regard to public accountability.

To the Editor: It’s time our profession took a bolder initiative with regard to public accountability. Whenever an organization, research firm, government agency, or other publishes data indicting physicians for their role in medical errors, poor outcomes, failure to police fellow practitioners, or issues relevant to quality of care and patient safety, our collective response has been twofold: provide all the “moss-covered” arguments about why certain information already available is not reliable and valid and therefore cannot possibly be of value to challenge the question at hand, and offer a “potential” solution designed, “over time,” to respond to the public’s growing anxiety. A most recent reference is to the Institute of Medicine’s reports on deaths due to treatment errors and the notion to make public the National Practitioner Data Bank information. I sincerely respect those who advocate proper study design to address specific quality issues; absolute perfection before performance information is released; perfection regarding data reliability and validity; and perfection in how data are adjusted to account for patient risk factors. I also respect those who demand that all information be accompanied by comprehensive data interpretation caveats. I adhere to all of this. But there is clear evidence that valid and reliable data are already available (albeit, not perfect) and that these data accompanied by proper interpretation caveats are useful in partially satisfying public accountability and meeting consumer demands, accelerating the rate of continuous quality improvement and improving patient outcomes, and thwarting consumer attitudes inherent in the “Avis syndrome” associated with our profession. Is it true that we are a nation that is “data rich” and “information poor”? Or is it simply a matter of the data’s not being perfect? The very practice of medicine is imperfect. That is why what we do as physicians is called “practice”—we expect to improve with practice—and referred to as a “work-in-progress.” Physicians—allopathic and osteopathic—never allowed imperfections in medical technology to thwart treatment of our patients. Otherwise, our treatment of patients would be limited to whole-leaf digitalis and thyroid abstract, the only medicinals available a century ago. Today, most of us strive to apply evidence-based practice standards to the care of our patients. We should not allow the imperfections of measuring and comparing quality and safety to interfere with the use of and advancement of the art and science of measuring and comparing the quality of healthcare we provide individually or collectively. Perhaps in the opinion of some, I am not qualified to make this assessment or render my opinion. Nonetheless, please allow me to present my qualifications. I have been an osteopathic physician since 1963, a practicing pediatrician from 1969 to 1981, and a health system chief medical officer from 1981 to 1992. My introduction to the frustrations of purchasers and consumers with regard to information about quality began in 1989, when I became directly involved with the Cleveland Health Quality Choice Program. This 10-year experience placed me at the very interface of provider-purchaser interaction regarding the access, cost, and quality of healthcare in Cleveland. Employers and consumers want and need valid and reliable information that will help them make more informed purchasing decisions. If we truly believe, as osteopathic physicians, that we offer “value-added” services to patients, then we should be in the forefront (as a profession) of developing and advocating the use of present-day information to assist consumers to make more informed healthcare choices. Most important, we should be in the forefront of pursuing and advocating advanced and innovative methodologies to meet purchaser consumers’ needs for usable information. Our efforts should not be solely directed to constructively criticize and “debunk” available data sources and portended uses of available information. We must also and bilaterally advance new, innovative ideas that will meet the needs expressed by those who must choose, purchase, and pay for the care we render. I urge as a profession that we seek a careful balance between our adversarial position regarding the use of available data and assume an advocate role proffering viable solutions to the expressed need. It is important to listen to the members’ concerns, but also the concerns of our patients. I am proud to serve as a consultant to the American Osteopathic Accreditation Program Task Force on Quality. At our most recent meeting in April, the Task Force was informed that it will be recommended to assume a larger role with regard to quality within the ranks of the AOA. In delineating a mission and charge for the group, I sincerely hope that this group will be invigorated and supported in its efforts by the consensus support of the AOA trustees and membership and directed to take an innovative lead in quality.