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DHMC symposium: Health-care data should be made public

Americans know more about the safety, quality, and efficiency of the cars they drive than of the places they seek medical care. Why? Because over the years not many hospitals and clinics have collected data about their performance—such as the number of inpatients who die from a heart attack or the satisfaction of patients upon discharge—and only recently have a select few made such data available to the public. (See page 16 for news on DHMC's actions in this regard.)

But measuring and reporting outcomes is just what's needed to improve U.S. health care and stymie skyrocketing costs, said six national health-care leaders who gathered for a symposium at DHMC in late May.

"We have made a commitment to transparency, a commitment to making the information that patients need . . . available, and using that information for improvement," says Paul Gardent, executive vice president of DHMC, after the event. But "we don't want to simply look within the walls of our medical center," he adds. He and other Dartmouth- Hitchcock leaders want to "think more broadly and more strategically about the health information needs" of the future.

Ideas: To bring forth new ideas, Gardent and Dr. Thomas Colacchio, president of the Dartmouth- Hitchcock Clinic, hosted a symposium titled "Medicine, Metrics, and Transformation: Making the Important Choices." More than 250 clinicians and administrators from regional hospitals, clinics, and organizations, as well as government officials, attended.

Keynote: The keynote speaker was Dr. Kenneth Kizer, who as undersecretary for health in the Department of Veterans Affairs was largely responsible for transforming the ailing VA medical system into one of the best in the world. "Modern health care is the most information-intensive enterprise that human beings have ever engaged in," Kizer told the audience. "Yet we're trying to manage it, and trying to operate in many cases, the same way we did 100 years ago. We simply can't get to where we need to go today without bringing health care IT [information technology] into the 21st century."

But getting "where we need to go" is about more than computers and data, Kizer and the other speakers said. "The other piece . . . is leadership and commitment and understanding of the direction in which [the data] can take you," said Dr. Louise Liang, senior vice president of Kaiser Permanente, a nonprofit HMO and the nation's largest. "I think it's very clear," she added, "that [DHMC], this community, has [that] other piece."

Dr. Donald Berwick, CEO of the Institute for Healthcare Improvement, also praised DHMC, reminding attendees to stay focused on patients—"a reminder you don't need at Dartmouth."

DHMC is indeed a national leader in outcomes reporting and quality improvement, as recent articles in the Wall Street Journal, the New York Times, and the Washington Post have attested. Faculty in Dartmouth's Center for the Evaluative Clinical Sciences (CECS)—such as Dr. John Wennberg, the first person to draw attention to regional variations in care—have been studying the delivery of care for more than 20 years.

Two CECS faculty members, Dr. Elliott Fisher (whose research suggests that 30% of U.S. health-care dollars go to unnecessary treatments) and Dr. Gerald O'Connor (who cofounded the Northern New England Cardiovascular Disease Study Group) also spoke. Both talked about how data can change clinical outcomes. O'Connor, for example, described a collaboration among five hospitals that has dramatically cut their combined mortality rate for heart-bypass surgery.

Fisher and O'Connor also urged academic medical centers to lead the way. "If we . . . look at how we compare to other academic medical centers," pointed out Fisher, "we can teach our residents and our students about re- flective practice."

"We have gotten a lot of recognition for our efforts," Gardent says later. But he's careful not to exaggerate DHMC's accomplishments nor to diminish the challenges that remain. It's the combination of "science plus measurement plus reporting," adds Gardent, "that will lead to much higher levels of quality and reliability."

Jennifer Durgin

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