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    Put to the test

    A possible role for clinical trials in modifying U.S. healthcare system

     

    Seems logical, right?

    A few years later, a study was performed to see the effects of the new rules. Guess what? A JAMA Internal Medicine paper reported that the 2,300 residents questioned did not sleep more hours and did not have reduced risk of depression. In a confidential survey, they self-reported that they had committed more medical errors that harmed patients after the new rules went into effect.3

    How can this be? One possibility is that the more-frequent handing off of patients from one resident to another results in the risk of some important information falling through the cracks, and more patients being harmed by an error. The authors conclude that “further study is needed to assess what’s happening.”

    Now, I am certain no one proposes new rules with the goal of increasing the numbers of injured and dead patients. It seems only logical that we should require—before allowing the widespread implementation of well-intentioned dramatic changes to our healthcare system—the performance of well-designed controlled trials comparing the proposed change with current practice.

    For example, if some group wants to mandate a change, such as instituting a new single-payer system (along the lines of Canada or the United Kingdom), wouldn’t it make sense to test this prospectively in a region of the country and carefully document the pluses and minuses? Then there are no surprises and before seriously enforcing the new rules, we know the consequences.

    Vermont spent 4 years planning implementation of a single-payer system before pulling the plug when Gov. Peter Shumlin (D-VT) decided “the risk of economic shock is too high.”4

    Too bad. I say let’s have one or more states, Vermont or others, conduct the controlled clinical trials before we seriously consider going nationwide with new policies.

     

    References

    http://www.medindia.net/news/program-to-reduce-hospital-readmission-increases-risk-of-death-174581-1.htm

    http://www.onlinepcd.com/article/S0033-0620(15)30016-5/pdf

    http://www.uofmhealth.org/news/archive/201303/paradox-young-docs-new-work-hour-restrictions-may-increase

    http://www.nejm.org/doi/full/10.1056/NEJMp1501050

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