For those who say no to results reporting -- you're too late! Healthcare professionals have begun to recognize the need to evaluate total information -- not waiting for costly, long-term clinical trials -- to improve healthcare delivery. APACHE is a first step for Intesive Care Units (ICUs).

This system is not actually capturing results data – it "analyzes patient data to rate the severity of acute illnesses and probabilistically predict outcomes." Then doctors in the ICU can use these risk-adjusted predictions to evaluate how their patients are doing. Now this is a little technical for me, but as I understand this, doctors can determine if their patients are doing as well as the predictions (based on clinical data) say they should be doing.

This was developed by A Dr. Knaus in 1978! So, this is not a new idea. The first roadblock – no surprise – was funding. No one wanted to pay to continue collecting the data and create prediction models. Then Cerner Corporation bought APACHE in 2001.

The system was continuously updated. But some ‘members’ of the medical community demanded ‘expensive and time-consuming clinical trials’ be conducted. They wanted to have ‘each specific aspect of process improvement’ documented before they’d accept and use it. That just slowed the whole effort down.

Despite that, for over a decade, the Mayo Clinic has used APACHE successfully and found some areas to improve to save more lives. And now hundreds of hospitals use APACHE. But public reporting of ICU results is not required! So yes, each hospital may be able to make internal improvements, but they can’t learn from each other to make wide-scale improvements! Jeez!

Looking at it from a patient’s perspective, you could go to a hospital that uses APACHE thinking it’s got the latest and greatest ICU, when in fact, it never learned some aspects of ICU care that another facility found could kill you! Worse yet, even they wouldn’t know they didn’t have the best care possible – so they’d turn around and do the same deadly thing to the next patient! Who decided this makes sense??!!!

Excuse me, but this kind of deadly arbitrary CYA activity just drives me crazy.

Now, something called the Joint Commission on Accreditation on Healthcare Organizations (JCAHO), has endorsed APCAHE, but they only use process performance (not actual patient results) for determining endorsements. Although following a proven process is a good thing, by itself, it’s not enough. You can do all your paperwork correctly and still kill the patient! We need this evaluation system to be fully enacted by including patient results.

Now, I’m not big on ‘big government.’ Nor do I like the idea of over-regulating an industry. But, "providers’ fears of accountability for results" are holding back the measuring of results which would naturally lead to improvements in our overall health and lower costs. That’s why we have to legislate results reporting.