Outcomes data can be confounded by patient factors like burden of illness, and they are time consuming and expensive to collect.

That’s why many quality measurement programs focus on process quality and cross their fingers that the link between process and outcomes actually holds true.

Uh, guys…can we huddle up a minute?

Leslie Kernisan and colleagues at UCSF just finished a study to determine whether performance on a set of process measures known as Safe Practices for Better Healthcare could predict hospital mortality.

They couldn’t.

Hospitals with higher scores on the Safe Practices indices did not have lower inpatient mortality than those with lower scores. Progressing from the worst to the best quartile on Safe Practices, inpatient death rates bounced around from 1.97% to 2.04%, to 1.96% to 2.00%.

Data from more than 1,000 hospitals were analyzed. These data were adjusted for patient and hospital variables that could impact the results.

“It is possible that inviting hospitals to self-report on their patient safety practices and then assigning them to quartiles of score is not an effective way to assess hospital quality and safety,” stated the authors.

That may be, but it’s more likely that inpatient mortality rates are not sensitive enough as measures of quality. Before throwing in the towel on these process measures, scientists would be wise to see how well they predict other, more sensitive outcome measures like readmission rates, functional status at discharge and 6 months, and so forth.

Then again, they could be lousy process measures, or the data collection tools could have been flawed.

The Safe Practice Guidelines have been endorsed by the National Quality Forum. The write-up appears in JAMA.

Last fall, Google’s philanthropic division released Flu Trends, a tool that purportedly predicts regional influenza outbreaks 7-10 days faster than traditional methods. The bio-surveillance tool relies on the fact that people use Google to search flu-related terms well before calling their physicians.

Now, a study of similar methodologies appears to show that the Mountain View-based company’s omnipotence extends to the prediction of economic trends as well.

Hal Varian, an economics professor at UC Berkeley who moonlights as Google’s chief economist, and  Hyunyoung Choi, a Google employee tested the hypothesis that variations in search frequency for certain phrases improves the accuracy of econometric models used to forecast retail and home sales, among other things.

Such data are available to the public through Google Trends, which enables interested parties to access reports on search volumes for particular categories and terms. The reports are updated daily.

The scientists found that addition of such information improves the predictive value of the standard models used to forecast car and truck sales by 18%.

Similarly, search volume on terms like Hong Kong and other ports of call carried out in Australia, India, the UK and the US can foretell bumps in tourist volume to these locations.

The tool still needs refining, however. The scientists showed for example that searches for real estate agents are better predictors of future home sales than those for home financing.

In an effort to buffer or perhaps counteract private sector influence on the treatment decisions of its physicians, Partners HealthCare will soon enact new rules of engagement for its panels.

Partners, which includes Brigham and Women’s Hospital and Massachusetts General Hospital, has decided for example to prohibit its physicians from accepting gifts and meals from Big Pharma and medical device firms.

Also banned will be cross-country junkets as paid members of “speakers bureaus” and ghostwriting, a practice in which scientists allow themselves to be included as authors on scholarly manuscripts penned by folks on drug company payrolls.

The plan will also tighten rules on how and when drug reps can visit physicians in the hospital, and include disclosing to the public more information about the nature of the relationships its physicians have with Big Pharma. Details of this latter change have yet to be worked out.

“We don’t want our faculty being on the road” as “hired guns,” Mass. General president Peter Slavin told the Boston Globe. And those free meals are history as well because they don’t “promote a positive image of physicians and increase healthcare costs,” he added.

The new policies were announced months after congressional klieg lights found Harvard-affiliated psychiatrists that might have engaged in improper relationships with Big Pharma. 

Republican Senator Charles Grassley has for example, accused Joseph Biederman of failing to reveal he’d pocketed $1.5 million in fees from Big Pharma between 2000 and 2007.

The moves did not completely satisfy HMS professor and former New England Journal of Medicine editor Arnold Relman.  He told the Globe “there should be no, zero, industry funding for any particular educational program,” involving Harvard-affiliated physicians.