Stanford professor of psychiatry Keith Humphreys illustrates the value of making sure your performance metrics match what you consider a successful outcome. Alas, too many do not:
Consider four psychiatric patients, all discharged from an inpatient unit on the same day following stabilization of an acute psychotic episode. A week later, the following events takes place:
Arnold’s symptoms return and in despair he commits suicide.
Barbara’s symptoms return and she goes on a cocaine binge, fueling her aggressive tendencies to the point where she punches a cop, landing herself in jail.
Carlos’s symptoms return and he becomes convinced that his apartment is full of listening devices. He moves to living under a bridge far from town.
Derrick’s symptoms return, and, having learned about his illness in the hospital, he recognizes the problem and returns to his site of care. He is admitted for 24 hours, re-stabilizes, and is then maintained as an outpatient in the community.
So, why would some powerful players in our health care system consider Derrick to have had the worst outcome? Because he and not the others was re-admitted to care within 30 days of discharge.
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If you follow the logic of the anti-readmission crowd out, you arrive at the conclusion that the best hospitals are those that close and those that kill every patient on the surgical table, because both types of facilities have a re-admission rate of zero.
