I found this as a reply to another blog I read and I had to post it:
Statistics are like a bikini – what they show is important but what they hide is vital
Monthly Archives: February 2013
Quality Measures That Don’t Matter: The Case Against Influenza and Pnemococcal Vaccination Rate Measures
It struck me today as was listening to the radio and reviewing an email summary of articles that I get every day that 2 “quality” measures that I am held accountable for don’t really help much. I am talking about this year’s influenza vaccine and the pneumococcal vaccine.
Lets start with the influenza vaccine. Where I practice I am supposed to make at least 79% of my patients over age 65 yrs of age take the vaccine. This doesn’t sound too bad right? Why shouldn’t it be 100%? Well the problem this year is that the influenza vaccine mostly sucks in this age group….per the CDC its only 9% effective in persons 65 yrs of age and older . (http://www.cdc.gov/MMWR/preview/mmwrhtml/mm6207a2.htm?s_cid=mm6207a2_w)
What about the pneumococcal vaccine? It should really help people right? I am supposed to make 95% of my patients take this vaccine. Well it kind a sucks also per Moberley S, Holden J, Tatham DP, et al. Vaccines for preventing pneumococcal infection in adults. Cochrane Database Syst Rev. 2012 Jun 22;1:CD000422. DOI: 10.1002/14651858.CD000422.pub3. This well done Cochrane review found that invasive pneumococcal disease was prevented by the vaccine but not pneumonia or mortality. So all it really prevents is bacteremia if you get pneumococcal pneumonia but it actually doesn’t prevent pneumonia. Somewhat of a misnamed vaccine if you ask me.
There is little benefit of these 2 vaccines but yet I am supposed to recommend them to my patients. I don’t have great vaccination rates in my patients. Maybe I won’t feel so bad about that any longer. The policy wonks who make up these rules need to look at the data and measure what’s important. Unfortunately they don’t. They are mired in their measurement mentality without the benefit of an intellect.
A New Format to Teach EBM That Worked Really Well
Last month I gave my final lecture of the year on EBM. I talked about diagnostic testing but used a new format. Well it isnt really a new format as we do this in another setting but it was new for EBM lectures. I presented a case, actually a few cases, to a colleague of mine and we discussed the approach to diagnosing these cases and sprinkled in the EBM topics along the way. The process is labelled “clinical problem solving” at UAB. Basically a presenter gives snippets of information to a discussant. The discussant walks the audience through his or her thoughts after each snippet of information is given.
I did the same thing but applied to teaching EBM principles of diagnostic testing. I gave information and asked the discussant what he thought the patient’s pretest probability was. I gave more information and we discussed testing and treatment thresholds. I gave more info and we discussed how to get to posttest probability. We covered sensitivity, specificity, LRs, choosing tests, determining posttest probability. I had quite a few questions for the audience (using our ARS) and they could compare their answers to that of my discussant.
I only changed up the format because I was bored giving the same lectures year after year. I was amazed at the evaluations of the discussion. I didnt get across all the info I normally would have but it didnt matter. We engaged the audience and demonstrated EBM in action. We demonstrated clinical reasoning (using EBM). I look forward to doing this more in the future.
ebmteacher 