Thursday, December 4, 2008

Even the Dartmouth Atlas Folks Are Worthy of Some Criticism

Think that publishing results in peer review medical journals should be the the 'proof' you need for your approach, your product or your point of view? That having the data appear in print gives you a golden pass? That by including those scientific reprints in your marketing materials, doubts about your company's value-add should fade away like the promise of a well run Medicare physician pay-for-performance payment program?

The Disease Management Care Blog feels your pain. It recalls an encounter with a health system leader at a holiday reception years ago. After having just published a paper on a successful reduction of costs for a chronic heart failure population, he dismissed it as having a 'voodoo' methodology.

By now, most of us in the disease management/population health business have learned the hard way that getting your positive results 'published' isn't the Easy Button you'd think it is. It is the nature of science to constantly scrutinize, challenge, seek additional insight and to be skeptical. The DMCB concludes there are two sides to this coin: on one side is the oxygen-deprived environment of 'therapeutic nihilism,' where nothing can be concluded and everything can be questioned. On the other is the unsettled 'journey-not-destination' of clinical research that helps us be smarter today than we were yesterday.

Both sides of this coin involve some swordsmanship. And if it's a little guy doin' the skepticizing, the spectacle is all that more richer. Which is why the DMCB found the multi-manuscript on-line Health Affairs jousting between Dr. Richard Cooper of the University of Pennsylvania's Leonard Davis Institute and the self-assured giants at the Dartmouth Atlas so enjoyable. Dr. Cooper used State by State quality measures and physician data to conclude that there is a positive correlation between specialist physician supply and quality. Nonsense sniffs the Dartmouth Atlas folks. Dr. Cooper calls their conclusions about a negative correlation a 'myth.' Dartmouth Atlas says they have 30 years of research on their side and that Dr. Cooper is 'incorrect.'

Much of the parrying is over some relatively obscure brain-aching epidemiologic principles, like the magnitude of correlations, the presence of any confounders and the statistical methodologies. Even the DMCB will need to read these papers several times to gain additional insight.

But, in the meantime, the next time you or a colleague are unsuccessfully trying to convince a group of the merits of your program, the worthiness of your product or the value of your outcomes, keep in mind that even the Dartmouth Atlas folks can get beat up from time to time. Remember, according to Wayne's World, only rock star Alice Cooper deserves to be humbly approached on bended knee with cries of 'we are not worthy!'

In contrast, the rest of us in this business are worthy of being criticized. Let the games continue.

Hat tip: HealthHombre.

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