tag:blogger.com,1999:blog-4968787219619380438.post3334388570030125703..comments2023-09-21T04:02:29.457-04:00Comments on Skeptical Scalpel: Big data is not big enough Skeptical Scalpelhttp://www.blogger.com/profile/13206922456661320751noreply@blogger.comBlogger8125tag:blogger.com,1999:blog-4968787219619380438.post-90294170166270620092015-07-20T09:26:54.651-04:002015-07-20T09:26:54.651-04:00The info is not merely incomplete. The methodology...The info is not merely incomplete. The methodology is flawed. Here are links to 2 of the many posts that have dissected the scorecard: https://twitter.com/buckeyesurgeon/status/622888610140811264 and https://ejsmdblog.wordpress.com/2015/07/20/propublicas-surgeon-scorecard-call-for-peer-review/Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-34211238329873182722015-07-19T15:13:53.479-04:002015-07-19T15:13:53.479-04:00Skeptical scalpel-- the fact that the information ...Skeptical scalpel-- the fact that the information is incomplete (many general surgeons not included) does not make it wrong.<br />There is enough data to show several very important things: a) while some surgeons account for very few complications, others are at the other end of the bell curve and probably shouldn't be operating. <br />Moreover, even within a single, brand-name (or marquee) hospital you see wide variation. Any surgical nurse knows this (though she won't tell you unless you are a relative. Nurses are afraid of being fired or sued. Maggie Maharhttps://www.blogger.com/profile/06174753119025304589noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-48335877164272114912015-07-17T10:19:09.807-04:002015-07-17T10:19:09.807-04:00And at worst, it is worse than nothing. For exampl...And at worst, it is worse than nothing. For example, Some of the surgeons in the scorecard may erroneously be labeled as having excessive complications and the converse is also true. Some who fall in the low rate of complications may actually be bad surgeons.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-41196081736066504972015-07-17T10:03:42.835-04:002015-07-17T10:03:42.835-04:00"Bad data may be worse than no data at all.&q..."Bad data may be worse than no data at all."<br /><br />Indeed, the hamartia of many meta analyses. Garbage in, garbage out. Bad data isn't better than nothing, at best it is only as good as nothing.Windrivenhttps://www.blogger.com/profile/10273522346544078081noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-29654879135716614762015-07-17T08:50:16.717-04:002015-07-17T08:50:16.717-04:00Windriven, that is a good question with no clear a...Windriven, that is a good question with no clear answer. Administrative (billing) databases such as the one used in the Surgeon Scorecard are inadequate for comparing clinical outcomes. A whole new clinical database needs to be set up. Problems include who will do this monumental task, how will data be submitted and analyzed and who will pay for it. <br /><br />Proponents of the Surgeon Scorecard say it is better than nothing. I disagree. Bad data may be worse than no data at all.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-87789819149179204632015-07-17T08:18:46.457-04:002015-07-17T08:18:46.457-04:00Points well made. How then is the medical consume...Points well made. How then is the medical consumer to evaluate and select a surgeon? The physician community is often perceived, and rightly I think, to be slow to address even egregious shortcomings among its members. If the community is unable or unwilling to adequately police itself, it should at a minimum work to establish objective metrics for medical consumers to employ. It is to my mind an issue of informed consent.Windrivenhttps://www.blogger.com/profile/10273522346544078081noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-80289688390655415012015-07-15T08:48:18.992-04:002015-07-15T08:48:18.992-04:00I agree completely. One of the authors of an artic...I agree completely. One of the authors of an article that accompanied the Surgeon Scorecard release has confirmed to me that the laparoscopic cholecystectomy data only involves inpatients. That not only skews the data it also eliminates the vast majority of laparoscopic cholecystectomies from consideration. This is why so few general surgeons are listed. As I said, the scorecard is useless for comparing general surgeons.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-29862660348864230512015-07-15T00:09:06.979-04:002015-07-15T00:09:06.979-04:00Using only the inpatient cases for an operation mo...Using only the inpatient cases for an operation most of us do as outpatient skews the data. I can understand their saying comp rates were same whether in or out patient, but clearly left us that strive to keep patients out, save costs, out of the analysis. Also prob skews up the overall complication rate, since the inpatients are prob sicker & more prone to complications. Most of my inpatient Medicare gallbladders come thru the ER being ruled out for MIs.<br /><br />Would almost argue that inpatient Medicare gallbladders are, almost by definition, not the elective operation they were looking to study.DrSouphttps://www.blogger.com/profile/14333872060444088395noreply@blogger.com