Researchers want a better system for fixing bad science | The Verge

Dean F. Sittig Dean.F.Sittig at UTH.TMC.EDU
Wed Feb 10 19:42:14 UTC 2016


Bob:
I think you have fallen into one of the common "big data" traps. While the data you provide is most likely correct, it does not include any context that might help us interpret the values.
So for example, if you consider the median age of the populations of these countries, you might be able to see that the USA spends so much because our population is so much older than the others on the list (Singapore being an exception). Now you need to think about what other factors might account for these differences. One that comes to my mind is how we treat those elderly people that are close to death? Do they die in the ICU or their home. I would wager that in the USA they die in the ICU, thus the statistics showing the large percentage of all healthcare costs that are spent in the last 12 months of life. I would bet that in these other countries they allow them to die a more natural death at home. Check out: http://www.hhnmag.com/articles/3656-health-care-costs-and-choices-in-the-last-years-of-life

from  UN 2012 data: http://data.un.org/Data.aspx?q=united+states+of+america&d=WHO&f=MEASURE_CODE%3AWHS9_88%3BCOUNTRY_ISO_CODE%3AUSA

COUNTRY                                            Year                Median age (yrs)


Bahrain

2012

30.07



Brunei Darussalam

2012

30.14



Iraq

2012

19.5



Jordan

2012

23.06



Kuwait

2012

28.95



Oman

2012

25.88



Qatar

2012

31.64



Saudi Arabia

2012

27.03



Singapore

2012

37.88



United Arab Emirates

2012

29.37



United States of America

2012

37.3



From: Bob Latino [mailto:blatino at RELIABILITY.COM]
Sent: Tuesday, February 09, 2016 6:50 AM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] Researchers want a better system for fixing bad science | The Verge


The U.S. spends ~17% of its GDP on Healthcare or about $3 Trillion/yr (or ($9,323/person).  It is hard to believe we do not throw enough money at it.  It is how we use the monies so inefficiently and ineffectively that is the problem.  For all of the money thrown at HC, our mortality rates as compared to the rest of the world do not demonstrate ours was money well spent.  Why not?



To put this into perspective France and Switzerland spend 11% of their GDP on healthcare.  The Middle East spends much less (see below).



[cid:image001.png at 01D16408.27640F80]



Source: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/highlights.pdf

Source: https://www.cia.gov/library/publications/the-world-factbook/rankorder/2066rank.html

Definition: The crude death rate is the number of deaths occurring among the population of a given geographical area during a given year, per 1,000 mid-year total population of the given geographical area during the same year.



Because the manner in which death rates are collected, deaths due to 'medical' error are not uniformly collected or collected at all in many countries.  So the only uniform measure of death is called the 'crude death rate' around the world (see definition above).  Deaths due solely to medical error are included however, the split (%) is not discernible.  Regardless, when you look at the investment in HC as opposed to GDP, and overall crude death rate/1000 total population, the numbers are varied and quite startling.  Why do these countries with the lowest investment in HC as a % of their GDP, also have the lowest crude death rates in the world?



I know there are many researchers on this forum who will chew this up and explain to us the reasons; but as a layman, I am interested in learning why.



Irrespective of what the studies in the link Rob provided conclude, just sitting in any hospital for a day and observing, one can make a list of errors for themselves.  To me, it is hard to imagine a hospital stay without an error occurring the course of the delivery of care.  Both of my parents passed in the last 9 years and both were in ICU's for 2 - 4 weeks.  We stayed with them 24/7 during those stays.  I kept daily lists of the errors and worked with the Risk Managers to resolve.  I know what I am looking for, just think of those who do not and just 'trust' their care givers and their delivery of care systems. Are they told of these errors?



I believe Rob's point is not that the errors are not occurring, but what is the scope and magnitude of them?  How do we accurately identify, quantify and prioritize them so we can focus on solving them in a logical manner?  How do we do this in a fashion where actions replace words and change can be observable in the near term (instead of during our lifetime)?  Certainly there are more complex issues that will take longer to resolve but I believe the 80/20 applies here as well.  I suspect that 20% or less of the error types (Failure Modes we call them in my business) account for 80% or more of the total occurrences.  Certainly we can act on this 'low hanging fruit' in the 20% range (or what we call the Significant Few).



Bob Latino





Robert J. Latino, CEO

Reliability Center, Inc.

1.800.457.0645

blatino at reliability.com<mailto:blatino at reliability.com>

www.reliability.com<http://www.reliability.com>





-----Original Message-----
From: Robert Bell [mailto:0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG]
Sent: Monday, February 08, 2016 10:09 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: [IMPROVEDX] Researchers want a better system for fixing bad science | The Verge



http://www.theverge.com/2016/2/3/10897938/science-correction-process-problems-report-university-alabama<https://urldefense.proofpoint.com/v2/url?u=http-3A__www.theverge.com_2016_2_3_10897938_science-2Dcorrection-2Dprocess-2Dproblems-2Dreport-2Duniversity-2Dalabama&d=BQMFAg&c=6vgNTiRn9_pqCD9hKx9JgXN1VapJQ8JVoF8oWH1AgfQ&r=sPJ6cvqFFdxFqFrb97KoyYk0NuBfdKf4oSNscarc_mU&m=ObQFxjwVCP-zpY2mqkNovN2HGZFbgRoDoZW-4ZmjgLE&s=NmKuT14iiJ3aX8fC5dEYJBNm_pvjusRcJaQEk5W45Ec&e=>



This supoports the concept that the diagnostic infrastructure is overall in a bad state. Is money the big problem - too much or too little?



Rob Bell

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