The Prairie Doc Perspective

Finding quality in health care

By Richard P. Holm M.D.

When you walk out the door to buy a car, you have to take into consideration how much money you can spare and what is the quality of the vehicle you are about to buy. Balancing cost and quality is how we choose. It is all about checking the pocketbook and kicking the tires.

But pocketbook-tire thinking goes out the window when something bad is happening to you or the one you love and you arrive in the emergency room. With insurance or the government paying premium dollars for your care, and someone’s health is at risk, you expect the very best. But how do you measure what is best care?

Measuring quality in health care is the new goal of the Medicare bureaucracy. For example presently they are measuring how fast antibiotics are started on patients with infection; how often nurses and doctors wash hands; how the risk for clotting is prevented; how often patients have to come back to the hospital in case they were sent home too soon; and the list goes on. What’s more, all this information is becoming available to anyone on the internet, with the hopes that people will become smarter consumers, kick the tires more, and all of this will drive up quality.

However we should realize there are limitations to such a process. Sometimes the measurement standards are wrong; for example we have recently learned that it can be harmful to over-correct blood pressure or blood sugar. Sometimes the protocol encourages adding yet another medicine, which may encourage too many medicines, which in turn can be harmful. Sometimes quality measures encourage excessive testing or more medicine instead of more comfort and pain relief when the patient is certainly dying. And to top it off, I suspect sometimes what is measured may depend on how much money the hospital is spending on measuring rather than on caring for patients.

There are good things that have followed this trend, however. I have watched how old habits have changed to better ones, how nationally accepted important standards of care are becoming habits. The emphasis on safety is good, and I especially like what is being accomplished with “transitions of care,” or how well we are making sure the patient has a medical home to go to after the hospital experience.

Certainly quality of care is not the fanciness of a new building, richness of a lobby, or the expense of advertising. It has all to do with the quality of the people working within, the time they have to spend with you, how they transition your care to home, and the support the hospital gives to those people to do these important acts.

Measuring quality is a challenging goal, and you can bet there will be a lot more kicking of tires to come.

Dr. Rick Holm wrote this Prairie Doc Perspective for “On Call®,” a weekly program where medical professionals discuss health concerns for the general public.  “On Call®” is produced by the Healing Words Foundation in association with the South Dakota State University Journalism Department. “On Call®” airs Thursdays on South Dakota Public Broadcasting-Television at 7 p.m. Central, 6 p.m. Mountain. Visit us at

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