Saturday, November 16, 2013

'So, how bad is it?' update



The blog entry from October 20th, 2013 included a look at a study of the compensation of hospital executives. A quick reminder of the relevant portion of the blog entry follows:
"Another recently issued study, also by Dr. Jha, looked at hospital CEO pay and examined if  the level of pay was related to quality metrics. It concluded that they were not related and that while pay was "associated with" the number of hospital beds, whether the organization was a teaching hospital, its location (rural vs. urban), the amount of technology, and patient satisfaction, "... we found no association between CEO pay and hospitals’ margins, liquidity, capitalization, occupancy rates, process quality performance, mortality rates, readmission rates, or measures of community benefit." This reverberated like a bombshell in the news and the blogosphere, leading to thousands if not tens of thousands of articles such as 'Care, CEO pay not linked, study says.'  A closer reading of the study showed that a) they looked at the hospital quality metrics, community benefit, etc. numbers from 2008 and CEO pay from 2009, and that, b) the measures  chosen to be the proxy for 'quality' were a fairly limited subset of quality measures - "... composite measures of performance on processes of care for acute myocardial infarction, congestive heart failure, and pneumonia... from which we built patient-level hierarchical logistic regression models to calculate 30-day risk adjusted mortality and readmission rates..." It has been argued that the choice of metrics could have influenced the outcome... While this blogger certainly doesn't have the expertise to know if this is true, or to understand the effect this choice had on the outcome of the study, it is certainly clear to him that perhaps two of the three measures would seem to be less applicable to the quality efforts of, for example, children's hospitals!  True, an argument certainly can be made that Dr. Jha and his co-authors bear  no responsibility for the tsunami of articles stating that hospital  CEO salaries have no relationship at all to quality of care and medical outcomes, when in fact the evidence is more nuanced and, at best, was the case in 2008 i.e. five years ago... However, this blogger is focused (as is clearly stated above) on the "uncritical and megaphone treatment" of some studies, clearly present in this case!. "
Well, in the discussion I noted that there had been some push back on the choice of metrics, but that I personally don't have "... the expertise to know if this is true, or to understand the effect this choice had on the outcome of the study..." Here is an additional data point. In all fairness to Dr. Jha's choice of "... composite measures of performance on processes of care for acute myocardial infarction, congestive heart failure, and pneumonia..." his choice of a narrower set of just three outcome measures is supported by a study that found that a composite of these three measures do track fairly well with a much broader array of measures and that it can be used as a reasonable proxy for the same! Note: this does not detract from the fact that this is not applicable to all hospitals e.g. children's hospitals, or the larger point that I was trying to make... However, credit is due where credit is due!

 
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