Richard G. DAVIS said: "Well, I guess they got their desired professional recognition out of this publication."
This is a recognition SORELY needed. One of my prized collector's items is the 1987 HCFA Hospital performance report. State Associations and hospitals got one free. No one else in the Tennessee Medical Association wanted the report so the Exec gave it to me. That was the last report since AMA and AHA managed to squash the project. The annual report ceased after three editions, killed on the allegation that the data was "imperfect." Too bad we didn't require then same standard of all new drugs and the intestinal by-pass bariatric surgery popular in those days. Now here we are nearly 20 years later playing "catch up." Yes, there are REASONS to question such reports. My favorite is the JAMA May 1995 diabetes and A1c report. http://jama.ama-assn.org/cgi/content/abstract/273/19/1503 The hypothesis was all patients with diabetes should have had A1c determination at least annually. Though no longer in private practice, I had access to my former practice's FileMan database. While the study reported only 16 percent compliance in 1993, ours had been 58% in the same year. Since, at the time, I was employed by one of the top 20 (U.S. News & World Report), Universities I sought to report the data. However, I could secure no interest or statistical support in that institution. Today the same institution boasts of its advanced technology by citing their current A1c experience. It wasn't until a couple years later, hearing the term "self serving journal articles" that I realized the true impact of that landmark study. The study (performed on Medicare tapes) was on performance of GP's, FP's, and general internal medicine. It wasn't until later, after hearing about self serving journal articles, that I recognized a gap in the report. There was no reference to the degree of endocrinologist in the article. As the data was from Medicare tapes with the specialists identified, I have no doubt the endocrinologist information was available. The other awareness I had in reviewing this article and our data was I would have had less interest in publishing, had the data not made me look good. My hat is off to those with the courage and conviction to publish their blemishes. The article is a wake-up call to all. Thanks, thurman > -----Original Message----- > From: [EMAIL PROTECTED] [mailto:hardhats- > [EMAIL PROTECTED] On Behalf Of Richard G. DAVIS > Sent: Sunday, May 29, 2005 9:03 AM > To: [email protected] > Subject: Re: [Hardhats-members] Archives of Internal Medicine Article > > Well, I guess they got their desired professional recognition out of this > publication. > > It reminds me that repeatedly over recent modern medical history the > appearance of a treatment for an illness is reliably followed by a sharp > rise in the incidence of the disease. Do people get sick just because > there > is a treatment for the illness? As a matter of prevention then, the best > course of action is to avoid finding treatments for diseases. ??? > > Of course, the answer in "NO". But, do physicians begin to diagnose a > disease only after there is a treatment? > > Or, is the apparent rise in incidence of a disease an artifact of the > process of treatment and the footprints that process leaves behind. > > So, the incidence rate of Adverse Drug Events (ADE) is higher. Higher > that > what? What is the scale by which one can make such comparative > measurements? What are the norms for ADE and how are the ADR rates > measured > in other settings by a methodology that is also being used in this study > so > that the "higher" rates can be known in the present setting? > > The value in VistA on the subject of ADE is in its inherent ability to > measure the extent of the ADE's. Once this can be reliably measured, then > the process of control and eventual reduction of ADE's can finally begin. > > ...oh, yes, I forgot, since the introduction of insulin caused a steep > increase in the incidence of diabetes, we are going to cite the adverse > effects of insulin to justify removing it from the medical treatment > inventory. > > ...and, likewise, VistA should be avoided as well... > > DOH! > > Regards, > > Richard. > > > From: Nancy Anthracite <[EMAIL PROTECTED]> > > Reply-To: [email protected] > > Date: Sun, 29 May 2005 00:27:25 -0400 > > To: [email protected] > > Subject: [Hardhats-members] Archives of Internal Medicine Article > > > > The May 23rd issue of the Archives of Internal Medicine had an article > about > > the high rates of adverse drug related events noted in a VA Hospital. > The > > lack of decision support for selection, dosing and monitoring was cited > as a > > deficiency in the EMR that if corrected, might prevent some of these > > problems. The presence of drug interaction checking was mentioned. > > > > The abstract is here. > > http://archinte.ama-assn.org/cgi/content/abstract/165/10/1111 > > > > It is my understanding that there is some decision support already > present in > > VistA but it is less than the ideal according to this article > > > > I doubt any record system out there is ideal, but I can see this as > something > > that will be cited as a reason not to adopt VistA . I bring it to your > > attention so you will not be surprised by this also so that we can work > > toward adding more decision support to VistA with the help of the > medical > > community as it grows. > > > > I am hoping that the release of VistA Office and the web site that will > come > > with it will be a place for the VIstA users to debate and contribute > > specific decision support suggestions as well as templates, clinical > > reminders, etc. I hope that users within the VA will also be willing to > > contribute and that this will lead to improvements in VistA for > everyone's > > benefit. > > > > > > -- > > Nancy Anthracite > > > > > > ------------------------------------------------------- > > This SF.Net email is sponsored by Yahoo. > > Introducing Yahoo! Search Developer Network - Create apps using Yahoo! > > Search APIs Find out how you can build Yahoo! directly into your own > > Applications - visit http://developer.yahoo.net/?fr=offad-ysdn-ostg- > q22005 > > _______________________________________________ > > Hardhats-members mailing list > > [email protected] > > https://lists.sourceforge.net/lists/listinfo/hardhats-members > > > > ------------------------------------------------------- > This SF.Net email is sponsored by Yahoo. > Introducing Yahoo! Search Developer Network - Create apps using Yahoo! > Search APIs Find out how you can build Yahoo! directly into your own > Applications - visit http://developer.yahoo.net/?fr=offad-ysdn-ostg-q22005 > _______________________________________________ > Hardhats-members mailing list > [email protected] > https://lists.sourceforge.net/lists/listinfo/hardhats-members ------------------------------------------------------- This SF.Net email is sponsored by Yahoo. Introducing Yahoo! 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