I enjoyed attending last night's Founders Day Banquet. As I mentioned last week, two of our faculty members and an SMHS department were honored with awards:
In addition, recent UND retirees and 25 years-of-service honorees were recognized for their contributions to the University and the community of North Dakota over the years. Congratulations and well done to all!
And speaking of Dr. Combs, I’m very pleased to announce that after getting very strong and positive feedback from the faculty members in his department, I've reappointed Dr. Combs as chair of the department for our usual five-year term. He really has done an exceptional job of leading the department, carrying out his own research, and excelling as a teacher and mentor.
Last week I attended the quarterly meeting of the Liaison Committee on Medical Education (LCME), the national accreditation body for medical schools in the U.S. and Canada. As I mentioned before, I am a member of the LCME, and we, on behalf of the LCME, evaluated various reports and determined the accreditation status of about four dozen medical schools. One of the issues that we and other accrediting bodies struggle with is how to balance a school's educational processes—the pedagogical effort a school makes—with the school’s actual outcomes (especially regarding the production of competent, caring, and compassionate health care providers).
The importance of trying to balance process vs. results was highlighted by an article that I read recently by Dr. Ashish Jha. Dr. Jha, an internist at the Veterans Affairs Boston Healthcare System and the Harvard T.H. Chen School of Public Health, analyzed the Hospital Readmissions Reduction Program (HRRP) that is part of the Affordable Care Act. The HRRP was designed to reduce the frequency with which Medicare patients were readmitted to the hospital within 30 days after an initial admission for certain specified conditions (like heart failure). The premise underlying the program was simple—if patients got better care during their initial hospitalization, they’d be less likely to be readmitted subsequently. And the initial data appeared to show a significant reduction in 30-day readmission rates shortly after the program was initiated about five years ago. However, further analysis suggested that about two-thirds of the apparent reduction in readmission rates simply was due to a change in how the admissions were coded—the real reduction in readmission rates was considerably smaller than first thought. Regardless, there appears to have been an unintended consequence of the HRRP focus on readmission rates: overall mortality rates of patients in the program appear to have increased since the inception of the program!
Thus, the HRRP may be a cautionary tale regarding the interdependence of process and outcome measures. The HRRP focused on improving the process of care, but perhaps the single most important outcome measure (patient survival) actually may be worse. So whether we're discussing medical schools' accreditation or providers' actual health care delivery, how you do something is important, but what you achieve is even more so.
Finally, congratulations to the Lamoureux twins for their two goals that won Team USA the gold in women’s hockey at the 2018 Olympic Games. It has been 20 years since our last gold medal in women’s hockey, and the win—on a Lamoureux goal in a game-ending shootout—could not have been more dramatic. Talk about Leaders in Action!
Joshua Wynne, MD, MBA, MPH
UND Vice President for Health Affairs
Dean, UND School of Medicine and Health Sciences