Questionable care: Grattan Institute report

The Grattan Institute has published an August 2015 report entitled Questionable care: Avoiding ineffective treatment.

The overview explains:

In some hospitals, far too many people get a treatment they should not get, even when the evidence is clear that it is unnecessary or doesn’t work. Australia urgently needs a system to identify these outlier hospitals and make sure they are not putting patients at risk.

To show how such a system could work, this report examines five treatments that should not be used on certain patients. One is treating osteoarthritis of the knee with an arthroscope – putting a tube inside the knee to remove tissue. Another is filling a backbone (vertebrae) with cement to treat fractures. A third is putting patients in a pressurised oxygen chamber when it will not help treat their specific condition.

Expert guidance labels most of these five treatments do-not-do, yet in 2010-11 nearly 6000 people – or 16 people a day – received them. These procedures can harm. Some people who had them developed infections or other complications during their hospital visit. Some could have avoided the stress, cost, inconvenience and risk of a hospital stay altogether.

Do-not-do treatments happen in all states, cities and rural areas, in public and private hospitals. But the ones we measured only happen in a minority of hospitals, some of which provided do-notdo treatments at 10 or 20 times the average rate.

We also examined three procedures that are sometimes appropriate, but should not be offered routinely. Again, a few hospitals have very different treatment patterns from their peers. There are important reasons why clinicians sometimes choose inappropriate treatments. Evidence about treatments can be hard for clinicians to access, evaluate and use. Second, there is little systematic monitoring of where do-not-do treatments happen, leaving clinicians and hospitals in the dark about where problems might exist.

Finally, the health system does not manage this problem well. There are rarely major negative consequences for providing ineffective care. In fact, there are incentives that go the other way – hospitals and clinicians get income for giving ineffective care.

To fix the problem, the Australian Commission on Safety and Quality in Health Care should publish a list of do-not-do treatments. It should then identify public and private hospitals that provide these treatments more often than usual. There could be a good reason for a do-not-do treatment, but if some hospitals provide them consistently it is a real concern.

These outlier hospitals should be asked to improve. If they do not, a clinical review by the state health department should check whether the hospital is providing the right care. If it is not, and if it still fails to improve, there should be consequences for the hospital’s management and funding.

The approach in this report can easily be used for many more treatments, using evidence and data that governments already have. Governments should use the approach demonstrated in this report to make sure that far fewer people get the wrong treatment.

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