Cancer Answers 123

" Improving Hospital Based Patient Treatments By Data Driven Methods in a Cost Effective Manner"

Today's New York Times Business Section features an interesting article about the use of "Continuous Performance Improvement" (CPI) techniques in hospital settings, which utilizes methods borrowed from business models. ("Factory Finesse, In the Hospital', by Julie Weed -http://www.nytimes.com/2010/07/11/business/) While it addresses techniques to increase operational efficiency in hospitals and other healthcare facilities, it only hints at the utility for improving patient treatments.

In the current cost-conscious healthcare environment, evidence based decision making has been the new goal, and the randomized clinical trial (RCT) the "gold standard" for decision making when judging competing treatments.  While emotionally and logically, the RCT, like motherhood and apple-pie, appears to be the most definitive decision making methodology, the conduct of these trials for treatments other than medications (including gene therapy, immunotherapy and chemotherapy) for cancer patients requires patient numbers and time that are more often than not impractical barriers to their inception, let alone their completion.

As noted by Dr. John Waldhausen, Chief of the Division of Pediatic General and Thoracic Surgery at Seattle Children's Hospital, which has adopted CPI for both many hospital operations and some clinical processes, "CPI is the same scientific method we learned in medical school, including hypotheses, data collection and analysis.....It is not opinion and conjecture-it is data driven." (NYT,07/11/10, Sunday Business, p.6)

Perhaps we need to give more thought to employing these CPI techniques to procedural based therapies via medical procedures such as surgery, radiation therapy, interventional radiology techniques and other procedural based therapies where individual variation in physicians, patients and other factors make the conduct of randomized clinical trials difficult.  Streamlining the decision making process for selecting the most appropriate treatments for our patients, providing that it is done in a way that is scientifically valid,  is in everyone's interest: patients foremost, but also physicians, healthcare facilities and providers and third-party payers, both private and governmental.  

In the future I'll go into this premise in more detail.  JGS

James G. Schwade MD FACR FACRO FASTRO