Becker's Hospital Review

38 QUALITY IMPROVEMENT & MEASUREMENT Cleveland Clinic develops tool to determine patients' risk of developing complications By Mackenzie Garrity P hysicians at Cleveland Clinic have released a calcu- lator for patients with type 2 diabetes to determine their risk of developing major health complications over a 10-year period depending on their treatment path. "The calculator can be a useful tool for physicians and patients with type 2 diabetes and obesity. It shows a patient's risk of heart disease, stroke, heart failure, diabetic kidney disease and death over the next 10 years with usual care. It also shows how a patients' risk of those adverse events could change after metabolic surgery," said Ali Aminian, MD, a bariatric surgeon at Cleveland Clinic. It took two years to develop the calculator, known as the 10-year Individualized Diabetes Complications Risk Score. During two phases, researchers observed nearly 2,300 patients who underwent metabolic surgery and 11,500 matched patients with similar characteristics who received usual care. Phase one results showed patients with type 2 diabetes and obesity had a 40 percent lower risk of death and major ad- verse cardiovascular events if they underwent weight-loss surgery. Surgical patients also lost more weight, had better diabetes control and took fewer medications. During the second phase, researches used the same group of patients to identify predictors for different health outcomes. They used evidence-based models to build the risk calculator, which estimates the likelihood of a patient developing chronic conditions. "Based on the advice of subject matter experts, our team was able to explore 26 risk factors for the different out- comes, including risk of dying, in that large group of pa- tients," said Michael Kattan, PhD, chairman of the depart- ment of quantitative health sciences at Cleveland Clinic's Lerner Research Institute. "We then compared machine learning and traditional statistical techniques to identify the most accurate predication models for each outcome and built those into the calculator." n US lags behind other countries in care quality By Gabrielle Masson T hough the U.S. spends the most on healthcare globally, its quality per- formance doesn't necessarily reflect this when compared to other countries, ac- cording to a report published Nov. 7 from the Organization for Economic Co-opera- tion and Development. The Health at a Glance 2019: OECD Indicators report compares population health and health system performance from OECD members, candidate and partner countries' official statistics. Eight takeaways from OECD's 2019 report: 1. The U.S. had the second highest rate of obstetric trauma for vaginal deliveries between 2012 and 2017, reporting a rate of 11.1 obstetric traumas per 100 instrument- assisted vaginal deliveries. Rates varied from 0.7 per 100 deliveries for Poland to 16.4 per 100 deliveries for Canada. 2. In 2017, the U.S. had the 10th highest admission rate for avoidable asthma and chronic obstructive pulmonary disease out of 37 countries. The U.S. had 268 admissions per 100,000 cases, compared to 58 per 100,000 cases in Japan and 428 per 100,000 in Hungary. For avoidable congestive heart failure hospital admissions in 2017, the U.S. had the sixth highest rate, reporting 371 admissions per 100,000. Costa Rica had the lowest rate at 39 admissions per 100,000, while Poland had the highest at 511 admissions per 100,000. 3. The U.S. reported the fourth lowest percentage of hospitalized patients with one or more healthcare-associated infections in 2015-17. U.S. rates were slightly above 3 percent, behind Lithuania, Latvia and Germany. 4. In all countries, women diagnosed early with breast cancer had a 90 percent or higher probability of surviving the cancer for at least five years. Women in the U.S. had a 98.7 percent survival rate between 2010 and 2014. Women in Australia had the highest survival rate (99.5 percent). 5. The U.S. had the 9th highest five-year survival rate for colon cancer out of 39 countries with a rate of 64.9 percent. Korea had the highest (71.8 percent), followed by Israel (71.7 percent) and Australia (70.7 percent). 6. The U.S. had the fifth highest five-year survival rate for lung cancer between 2010 and 2014, with a rate of 21.2 percent. Japan lead with a mortality rate of 32.9 percent, followed by Israel (26.6 percent) and Korea (25.1 percent). 7. Nearly 82 percent of the time, U.S. patients reported that their physicians spent enough time with them during consultations in 2017. This figure sits above the OECD average of 80.6 percent but trails behind 12 other countries, with Israel leading at 96.1 percent. 8. U.S. patients reported that their physicians provided easy-to-understand explanations 89.8 percent of the time in 2017. Israel reported the highest rate (97.5 percent), followed by Portugal (96.3 percent) and Netherlands (96.2 percent). OECD noted that care quality is improving in terms of safety and effectiveness, but few health systems routinely ask patients about the outcomes and experiences of their care. n

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