Transcription:
Quality and Outcomes In the Hospital Setting

Melanie Cole (Host): With all the changes in the United States' health care system, it can be very confusing for the consumer when looking for a medical facility to meet their needs. Hospital systems are always evolving and finding new ways to serve their community. My guest today is Dr. Kyle Cologne. He's a colorectal surgeon and a member of the medical staff at Palmdale Regional Medical Center. Welcome to the show, Dr. Cologne. People want to know, when they're looking for a medical facility, what they should be looking for. What are the quality parameters that they should be looking for for their best health advocacy?

Dr. Kyle Cologne (Guest): Well, first of all, thanks for having me, Melanie. There are a couple of things that the consumer should look at and, just as an aside, there has been an explosion in recent years of quality-related metrics that are available to the consumer. Most of these are actually available on the web but a lot of different third-party website providers, as well as the government and Medicare, are now providing outcome-related data to help the consumer pick, not only their hospital system but also their provider, to get what would be the best quality outcome for them.

Melanie: How do they go about doing that?

Dr. Cologne: So, the first step is probably to do searches for healthcare-related outcomes. I will say that, and give a little bit of a word of caution about many of these, is they are not what we call in the health care industry "risk adjusted." So, what I mean by that is if you have a provider that's doing a lot of high-risk procedures, that may not play into the outcomes that you see listed. But, in general, they're a good starting point to look at hospitals and there are a variety of grading systems that can be used, depending on which website you use, so that can be a little bit confusing to look through. Basically, it will give you a good background, or starting point, for what sort of things you want to look for. Just to get into a little bit the types of rating systems, a lot of them are done by letter--grade A, B, C. But, again, a lot of these websites will tell you a little bit about what grading system they used and what that means. Really, what you're looking for is how the particular hospital you are interested in going to relates in a relative scale to other hospitals in your region.

Melanie: So, if you're looking at this kind of data and statistics, what does that tell the consumer about other things, that they're looking for like bedside manner, availability, and appointment schedules--that sort of thing?

Dr. Cologne: Sure. So, some of those metrics are actually included in a lot of these grading scales, but more so, what they're looking at is big picture health care systems issues. So, just to give a couple of examples, things like central line infections in the hospital and urinary tract infections associated with a catheter in the hospital. Those are a couple of the big things just to give you an idea of what these rating systems are looking at. Now, do those necessarily translate into for like, what I do, good colorectal care? Not necessarily but they are certain benchmarks that if the hospital is doing those things well, they're probably doing a lot of other things well.

Melanie: Well, that service quality is more difficult to define and measure because maybe everybody says one doctor's fantastic and you don't click with that person, so that's sort of a difficult measure for people to look at. What else do you want them to know about searching for this good quality to meet their needs?

Dr. Cologne: So, a lot of it also has to do, as you said, that it's a starting point to look for these quality-related issues, but then to drill it down to a more specific doctor/patient relationship level, those aspects you're really going to have to depend on your referring physicians who may know a lot of these doctors better; who may know their outcomes better. Then, actually go meet with these physicians that you're interested in talking to. At that visit, and I often encourage people to go get second opinions just to see what other people think for that exact same reason. You have to build a trust with your provider and there are a series of questions that you can ask as part of that visit that can help you determine is this potential surgeon that you're talking to, or any doctor for that matter, really concerned about the quality-related outcomes that the patients need to be aware of?

Melanie: How do socio-demographic factors influence this interaction between the hospital system and/or doctors and the patients, themselves?

Dr. Cologne: That's a very difficult question to answer. There are very region-specific demographics that may change the access to a particular physician or a hospital. For example, with just for me as a surgeon, I may be able to see patients at one hospital but not at another because of differences in their demographics or their insurance contracts. So, that's something to keep in mind. Oftentimes what will happen is an insurance company will tell a patient what is in-network or out-of-network and, obviously, there is an incentive to keep things in-network because that keeps costs down and cost is just one factor that plays into quality.

Melanie: So, how does provider motivation, for you as a doctor, influence how you deliver this high-quality care. You're a colorectal surgeon, so, certainly, now colonoscopies are in the media and preventive care. How does that go with you doctors as being motivated? Give us a little insider information.

Dr. Cologne: Sure. So, within colorectal surgery, there's been a lot of national pressure recently to improve outcome. As we've gained more understanding of what exactly that means, there have been several initiatives that help us do that from a provider level. I'll talk specifically about two of them. The first is something we call "enhanced recovery programs" after surgery and, basically, just to give a little bit of a background, what it used to be is, after surgery, we took things very, very slowly. So, after you did any surgery on the intestine, you would not feed any patients until the intestines gave us signs that they were working again. So, that does a lot of things like prolong the time you spend in the hospital and it prolongs the recovery time. As we've learned more and more about the physiology of these things, a little bit of that has gone away. So, the enhanced recovery programs that we do now are designed to decrease pain, shorten the time that you spend in the hospital, get you back to work faster--all of these things that are very good and we now realize that they are very safe to do. As part of that, we've also increased our use of laparoscopic or minimally invasive surgery again, for the same thing. We've proven that for a lot of areas it is safe and we are utilizing it wherever possible. The second area that we within colorectal surgery have focused on is infections following surgery. Specifically, what we call surgical site infections and there are a number of things that you can do as part of a program to decrease the risk of those. This is a very sort of scientific process that we go through and there are a number of components to that that we have in place at the hospitals that I go to.

Melanie: Dr. Cologne, where does preventative medicine fit in to all of this quality and outcome information for consumers?

Dr. Cologne: Sure, so you mentioned a little bit before, colonoscopy and that, within my world, is very near and dear to my heart are ways that we can use preventative medicine to stop things from happening before they do. So, one of the major purposes of colonoscopy is as a part of screening for colon cancer. The thought is that if we do a test, we can find a polyp and remove it before it ever becomes a cancer. That is really the crux behind why we do this procedure: the symptoms of colon cancer are that there are no symptoms. So, by doing a test where we get rid of a problem before it ever becomes symptomatic, then we can do things like avoid having to do colon cancer surgery, which is much more expensive, much more time-consuming and which requires a lot of extra resources. If we get everybody to do appropriate screening or on a population level, do the preventative health care things, then a lot of the things that come later on go away.

Melanie: Such great information. In just the last few minutes, Dr. Cologne, what should people think about when seeking care from a medical facility to be their own best health advocate?

Dr. Cologne: I think there are a number of things. Number one, and this is a very subjective thing, is do you feel comfortable with your provider? If you don't feel comfortable with your provider, then that's obviously the sign of a bad relationship. But, there are some things that patients can do to help improve their comfort level and their confidence with the ability of the hospital as well as the doctors to give them good quality care. I often tell patients that there are a couple of questions that they should ask, particularly related to surgery. Number one is what is their experience with doing this type of procedure? If you ask your surgeon, “How many times have you done this surgery?” and they say, “I do maybe one or two a year”, then that's, obviously, not as good as someone who does this every single day, day in and day out. The other thing is ask the doctors what their outcomes are and if they can give you a sense of what their results are, then, obviously, that's someone who cares about quality and who is focused on improving care for patients. The last aspect of that is ask any doctor or, particularly a surgeon, about what their qualifications and what their board certification is to be able to do these procedures.

Melanie: Why should they come to Palmdale Regional Medical Center for their care?

Dr. Cologne: So, I work mostly at USC and one of the things that Palmdale has done is they have sought out surgeons like myself to come to their facility to bring in regional expertise to improve the quality and really elevate the level of care that is available at Palmdale Regional Hospital. I think that's seen from the top down across all the leadership. As for the physician associations that are associated with Palmdale, everybody's really focused on quality and really trying their very best to help the patients in the region out.

Melanie: Such great information. Thank you so much, Dr. Cologne, for being with us today. You're listening to Palmdale Regional Radio. For more information, you can go to palmdaleregional.com. That's palmdaleregional.com. Physicians are independent practitioners who are not employees or agents of Palmdale Regional Medical Center. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks so much for listening.