Who do you want with you in a REAL fight?

I am taking no sides here, just sharing this cuz I found it laughing-out-loud funny.

Metrics in Healthcare

The New York Times has an interesting front page article on the impact of metrics and measurements in both healthcare and education.

Both are areas where quantified attempts to improve outcomes have been famously applied for years now (No Child Left Behind, Common Core, Electronic Medical Records, the Affordable Care Act a/k/a "ObamaCare") and it is possible to look at what the impact on these areas has been over the past years of widespread implementation.

The article does a good job of pointing out that some areas have seen improvement (lower infection rates in hospitals, improved attention to lower income public schools) and yet unanticipated downsides are also noted (doctor burnout rates of over 50%, loss of arts, music and physical education from school curricula).

Some of these are sort of predictable: if school testing is linked to funding and tests are largely on STEM (Science, Technology, Engineering, Mathematics), then of course arts and PE are going to be dropped because they're not on the test.

Some are less predictable: are poorly rated doctors and hospitals bad, or are they treating large populations of poor and/or seriously ill patients who aren't or can't be treated anywhere else?

It's particularly telling that MediCare has stopped a program that has linked payment to computer use by doctors, and that a ranking program by the program that inspects hospitals has been put on hold.

Avedis Donabedian, a professor at the University of Michigan’s School of Public Health, was a towering figure in the field of quality measurement. He developed what is known as Donabedian’s triad, which states that quality can be measured by looking at outcomes (how the subjects fared), processes (what was done) and structures (how the work was organized). In 2000, shortly before he died, he was asked about his view of quality. What this hard-nosed scientist answered is shocking at first, then somehow seems obvious.

“The secret of quality is love,” he said.

What do we know (or, not) about nutrition?

These links to Vox and Five Thirty Eight do a really nice job of showing how difficult it is to study nutrition and its effects on people's health, and also how difficult it is to sort out what you read about it.

The good news?

A healthy dietary pattern is higher in vegetables, fruits, whole grains, low- or non-fat dairy, seafood, legumes, and nuts; moderate in alcohol (among adults); lower in red and processed meats; and low in sugar-sweetened foods and drinks and refined grains.
Additional strong evidence shows that it is not necessary to eliminate food groups or conform to a single dietary pattern to achieve healthy dietary patterns. Rather, individuals can combine foods in a variety of flexible ways to achieve healthy dietary patterns, and these strategies should be tailored to meet the individual’s health needs, dietary preferences and cultural traditions.