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National Guidelines, Quality Measures Clearinghouses Shutting Down

If you or anyone at your hospital use the National Guidelines Clearinghouse or National Quality Measures Clearinghouse operated under the auspices of the Agency for Healthcare Research and Quality (AHRQ), download the information you need soon.

Both online clearinghouses will go dark after July 16 as federal funding runs out. Neither site is accepting new guidelines or quality measure sets in anticipation of shutting the databases down.

Announcements on each website note that that AHRQ has received “expressions of interest from stakeholders” that want to takeover maintenance of the databases, but AHRQ officials have declined to identify who those stakeholders are for now.

The clearinghouses were set up more than two decades ago as central sites to help hospitals, clinicians and others in health care find evidence-based information on which to set policy, create clinical treatment plans and objectively measure quality outcomes.

The guidelines and measures are submitted by various professional or academic health organization and must meet detailed criteria to be included in each database. As guidelines or measures are updated or become outdated, the information is removed.

AHRQ evaluating options

“AHRQ recognizes the importance of this resource and is evaluating potential options, including the participation of stakeholders who may wish to operate the Clearinghouse in the future,” stated Alison Hunt, MPH, with AHRQ’s Office of Communications, Media Division.

If public or private stakeholders are found to take over the clearinghouses, ARHQ still has not decided what role it will continue to play, Hunt said.

While the federal sites may go away, the information will still be available from each of the professional society, academy or other healthcare group that originated the material, notes Karen Schoelles MD, SM, FACP, director of ECRI Institute’s Penn Medicine Evidence-based Practice Center (EPC) and project director for both clearinghouses.

ECRI was the original contractor hired by AHRQ to set up and run the guidelines clearinghouse in 1987.

Besides having information in one place, one of the advantages in having each of the clearinghouses is that users could have some assurance that the information had been professionally vetted and was up-to-date.

Having evidence-based information to back a policy or best practice is one of the key mantras of both The Joint Commission and CMS.

Hospital leaders or others who need information about the validity of a particular set of guidelines or best practice can still seek out help from any of the Evidence-based Practice Centers (EPC) set up through AHRQ, says Schoelles. ECRI-Penn Medicine is one of 12 EPCs across North America.

EPC programs offer help

The EPCs develop evidence reports and technology assessments to assist public- and private-sector organizations, and “provide organizations with comprehensive, science-based information on common, costly medical conditions and new health care technologies and strategies,” according to a AHRQ research white paper released in December. Schoelles was a work group leader on the paper, A Framework for Conceptualizing Evidence Needs of Health Systems.

The paper sets out to determine the evidence needs of health systems to both guide future EPC programs and ultimately help organizations as they seek “evidence to inform decisions about acquiring new or emerging medical technologies; implementation or expansion of service offerings; and selection of governance, finance or delivery system models,” notes a summary.

As part of the group’s research it looked at information requests made at four large health institutions;  Kaiser Permanente Southern California, the Veterans Health Administration’s Evidence Synthesis Program, ECRI Institute’s Health Technology Assessment Information Service, and Penn Medicine Center for Evidence-based Practice.

“A wide range of clinical and administrative decision-makers requested evidence reviews, and the topics were similarly broad—ranging from evidence to guide clinical care; purchasing of medications and devices; procedural and non-procedural interventions; and processes of care,” according to the paper.

Highlighted throughout the requests was a need for trustworthiness of information, notes Schoelles.

If you are seeking to verify or evaluate information and are part of a larger health system, Schoelles suggests starting with the larger organization to see what help it can offer. Often health systems will evaluate a guidelines or best practice and then establish a policy or guidelines based on that information, or can share the evaluation throughout the system’s smaller organizations, she said.

ECRI, for instance, offers a variety of evaluation services. Some ECRI services are free to members, others are fee-based. ECRI Institute also is currently exploring ways to maintain a guideline repository, notes Schoelles.

Resources

This article was originally published in Inside The Joint Commission.

Study Questions Effectiveness of Performance Measures

study published in the New England Journal of Medicine asserts that the U.S. healthcare system does a poor job of measuring quality. The study’s researchers led by lead author Catherine McLean, MD, PHD, chief value medical officer, Hospital for Special Surgery, recommend that organizations should stop using performance measures until they can be assessed and revised.

The study notes that a recent survey found that 63% of physicians said that current performance measures do not capture the quality of the care physicians provide. The Performance Measurement Committee (PMC) of the American College of Physicians (ACP) had developed criteria to assess the validity of performance measures. McLean and researchers applied the ACP criteria to the measures included in the Medicare Merit-based Incentive Payment System (MIPS)/ Quality Payment Program (QPP), hypothesized that if most of the MIPS/QPP measures assessed were deemed valid using this process, physicians would have more confidence in using them to improve patient outcomes.

In this study, the researchers identified and rated the validity of 86 measures on the 2017 QPP list that were considered relevant to ambulatory general internal medicine. Of those, 32 (37%) were rated as valid by this method, 30 (35%) were found to be not valid, and 24 (28%) were of uncertain validity. For each measure, the committee rated validity using five domains: importance, appropriateness, clinical evidence, specifications, and feasibility and applicability.

“We believe that the next generation of performance measurement should not be limited by the use of easy-to-obtain (e.g., administrative) data or function as a stand-alone, retrospective exercise,” the researchers wrote. “Instead, it should be fully integrated into care delivery, where it would effectively and efficiently address the most pressing performance gaps and direct quality improvement. For now, we need a time-out during which to assess and revise our approach to physician performance measurement.”

CMS’ severe sepsis bundle ISN’T a Joint Commission requirement

The April 17 issue of Annals of Internal Medicine (AIM) incorrectly stated The Joint Commission was considering creating a requirement for hospitals to implement CMS’ Severe Sepsis and Septic Shock Early Management Bundle (SEP-1) to receive accreditation. This information is incorrect and AIM has published a correction.

Study: Improvement in Errors, Accidents, Infections

The Leapfrog Group this week released its spring 2018 Hospital Safety Grades, which found that hospitals have stepped up their game when it comes to reducing avoidable deaths from errors and infections. Leapfrog issues the report cards twice a year, grading hospitals on an “A through F” scale based on their patient safety efforts.

“The national numbers on death and harm in hospitals have alarmed us for decades. What we see in the new round of Safety Grades are signs of many hospitals making significant improvements in their patient safety record,” said Leah Binder, Leapfrog’s president and CEO, in a release. “Leapfrog Hospital Safety Grades have definitely spurred these improvement efforts. But the hospitals achieving new milestones are doing the hard work, and we salute them as the leaders, researchers and organizations fighting every year for patient safety.”

Leapfrog listed improvements including:

  • Five hospitals achieving “A” grades for the first time once had received “F”s
  • Since the report cards started six years ago, 46 hospitals have received an A for the first time
  • 89 hospitals receiving an A had at one point received a D or F
  • Strong performance from hospitals in states that once were ranked poorly, including Rhode Island, Hawaii, Wisconsin, and Idaho

Of the approximately 2,500 hospitals graded by Leapfrog, 30% earned an A, 28% received a B, 35% were given a C, 6% got a D, and 1% received an F. The states with the highest percentage of A-graded hospitals are Hawaii, Idaho, Rhode Island, Massachusetts, and Virginia. Hospitals with F grades are located in California, Washington, DC., Florida, Iowa, Illinois, Maryland, Michigan, Mississippi, New Jersey, and New York.

The Leapfrog Hospital Safety Grades are calculated by top patient safety experts, peer-reviewed, transparent, and free to the public. The report card is released each spring and fall.

Story first published in PSQH

Patient Safety Strategies: Building a Fall Prevention Toolkit

When: May 30, 1-4 p.m. EST

Speakers: Virginia Hall, DNP, MSN/Ed. RN, CNE

Carole Eldridge, DNP, RN, CNE, NEA-BC

Registration: http://hcmarketplace.com/patient-fall-prevention

Patient falls are a fixture in The Joint Commission’s list of top 10 sentinel events; in fact, they were the third highest sentinel event reported to the accreditor in 2016. Causes of falls can include inadequate assessments, side effects from medications or diseases, and environmental hazards, as well as a lack of leadership or staff orientation.

During this three-hour virtual workshop, Carole Eldridge, DNP, RN, CNE, NEA-BC, and Virginia Hall, DNP, MSN/Ed. RN, CNE, will provide a step-by-step guide to setting up a successful and sustainable evidence-based multidisciplinary fall prevention program in your facility.

Learn more about the workshop here.

Joint Commission Urges Hospitals to Protect Workers from Abuse

This story originally ran on HCPro’s OSHA Healthcare Advisor.

The Joint Commission is the latest healthcare heavy-hitter to call for better protection of healthcare workers, announcing on Tuesday the creation of Sentinel Event Alert 59, which addresses violence—physical and verbal—against healthcare workers.

About 75% of workplace assaults occur in healthcare and social service sector each year, and violence-related injuries are four times more likely to cause healthcare workers to take time off from work than other kinds of injuries.

The purpose of the new alert is to help hospitals and other healthcare organizations better recognize workplace violence directed by patients and visitors toward healthcare workers and better prepare healthcare staff to address workplace violence, both in real time and afterward, The Joint Commission wrote in this latest Sentinel Event Alert publication.

Sentinel Event Alert 59 has some overlap with Alerts 40 and 57—which were released in 2008 and 2017, respectively, and focused on the development and maintenance of safety culture—and therefore were not addressed in this alert.

Per the Occupational Safety and Health Administration (OSHA), about 75% of workplace assaults annually occurred in the healthcare and social service sector. Violence-related injuries are four times more likely to cause healthcare workers to take time off from work than other kinds of injuries, according to the Bureau of Labor Statistics (BLS).

The Joint Commission cites both of those facts in this Sentinel Event Alert publication and adds that Joint Commission data show 68 incidents of homicide, rape, or assault of hospital staff members over the past eight years—and that’s mostly only what hospitals voluntarily reported.

The Joint Commission is calling for each incident of violence or credible threat of violence to be reported to leadership, internal security, and—if necessary—law enforcement, and it also wants an incident report to be created. Under its Sentinel Event policy, The Joint Commission says that any rape, any assault that leads to death or harm, or any homicide of a patient, visitor, employee, licensed independent practitioner, or vendor on hospital property should be considered a sentinel event and requires a comprehensive systematic analysis.

Additionally, The accreditor says it’s up to the healthcare organization to specifically define unacceptable behavior and determine what is severe enough to warrant an investigation.

This Sentinel Event Alert, which you can download here along with other resources, comes on the heels of an emergency preparedness rule from CMS that recently went into effect and efforts from the National Fire Protection Association to fast-track its new standard for active shooter events and other violent incidents. OSHA is also considering a standard to help protect healthcare and social workers from violence.

HFAP to keep name going forward

HFAP will be keeping its name. The accreditor had originally planned to take the name of the Accreditation Association for Hospitals/Health Systems (AAHHS), which acquired them in 2015 from the American Osteopathic Association (AOA.)

AAHHS is a non-profit organization focused on quality and safety in healthcare and has been acting in a management capacity for existing HFAP accreditation programs since the merger.  According to HFAP media representative Mary Velan, to avoid the alphabet soup of switching from AOA/HFAP to AAHHS/HFAP, they plan to simplify by going forward as “HFAP”.

“We had considered a name change but HFAP has over 70 years of history behind its accreditation programs and we want our current and future customers to know that the practical, educational approach that is what HFAP delivers remains unchanged,” she said.

Even though the name change is off, HFAP members shouldn’t worry said Velan. The change in plan won’t affect any of the services provided by HFAP or its survey process.

“HFAP continues with its mission of advancing high-quality patient care and safety through objective application of recognized standards,” Velan said in an email.

She also added the accreditor is expanding their specialty care certification programs, including stroke, lithotripsy, wound care, joint arthroplasty, and compounding pharmaceuticals. HFAP is also working on renewing its CMS deeming authority prior to 2019 expiration dates.

Study: Link between infection control and antibiotic stewardship

Healthcare facilities must ensure that infection prevention and control (IPC) and antibiotic stewardship (AS) programs work together, according to a joint position paper released last week by the Association for Professionals in Infection Control and Epidemiology (APIC), the Society for Healthcare Epidemiology of America (SHEA), and the Society of Infectious Disease Pharmacists (SIDP).

An update to a 2012 paper that examined the roles of infection preventionists and healthcare epidemiologists in the use of antimicrobials, the new paper was published in the American Journal of Infection Control and Infection Control and Hospital Epidemiology. The new paper focuses on the synergy between IPC and AS programs, with emphasis on the importance of an effective IPC program as part of a strong AS strategy.

?The issues surrounding the prevention and control of infections are intrinsically linked with the issues associated with the use of antimicrobial agents and the proliferation and spread of multidrug-resistant organisms,? said lead author of the new paper Mary Lou Manning, PhD, CRNP, CIC, FSHEA, FAPIC, in an APIC press release. ?The vital work of IPC and AS programs cannot be performed independently. They require interdependent and coordinated action across multiple and overlapping disciplines and clinical settings to achieve the larger purpose of keeping patients safe from infection and ensuring that effective antibiotic therapy is available for future generations.?

AS programs strive to emphasize the appropriate use of antimicrobials to minimize overuse, improve patient outcomes, reduce microbial resistance, decrease infection spread, and preserve antibiotic efficacy, according to the release. AS programs are more effective when rolled out alongside IPC programs than they are on their own, the paper states.

A study recently released in the Joint Commission Journal on Quality and Patient Safety found that antimicrobial-resistant organisms lead to more than 2 million infections and 23,000 deaths each year in the U.S. The use of AS programs can reduce inappropriate antimicrobial use, length of stay, rates of antimicrobial-resistant infections, and cost, the researchers found.

This story originally ran in PSQH. 

CDC Warns of New Wave of Antibiotic-Resistant Germs in U.S.

A new Centers for Disease Control and Prevention (CDC) Vital Signs report released this week said health departments found more than 220 cases of germs with “unusual antibiotic resistance genes” in the United States last year. These germs include those that cannot be killed by all or most antibiotics, are not common to a geographic area or the U.S., or have specific genes that enable them to spread their resistance to other germs, according to a CDC release.

The CDC’s Antibiotic Resistance (AR) Lab worked with local health departments to deploy a containment strategy to stop the spread of antibiotic resistance. The first step is rapid identification of new or rare threats; after a germ with unusual resistance is detected, facilities must quickly isolate patients and begin aggressive infection control and screening actions, according to the release.

“CDC’s study found several dangerous pathogens, hiding in plain sight, that can cause infections that are difficult or impossible to treat,” said Anne Schuchat, MD, CDC’s principal deputy director, in the release. “It’s reassuring to see that state and local experts, using our containment strategy, identified and stopped these resistant bacteria before they had the opportunity to spread.”

After rapid identification of antibiotic resistance, the CDC strategy calls for infection control assessments, testing patients without symptoms who may carry and spread the germ, and continued assessments until the spread is stopped. It requires coordinated response among healthcare facilities, labs, health departments, and the CDC through the AR Lab Network.

The CDC study also found that about one in 10 screening tests of patients without symptoms found a hard-to-treat germ that spreads easily, which means the germ could have spread undetected in that facility. For carbapenem-resistant Enterobacteriaceae (CRE), the report estimates that the containment strategy would prevent as many as 1,600 new infections in three years in a single state, which would be a 76% reduction.

Story originally published by our friends at PSQH!

Avoid Eyewash-Related Regulatory Compliance Issues

Eyewash stations continue to confuse and confound healthcare organizations (HCO). Not only can they pose infection control and safety issues for workers, they can be a point of contention between HCOs and surveyors, who often seem to work by different sets of rules.

During this 90-minute webinar on May 31, former hospital administrator and accreditation expert John R. Rosing, MHA, FACHE, will explain what regulators like CMS, The Joint Commission, and OSHA expect from an HCO’s eyewash stations. He will provide the steps personnel can take to keep staff safe and the organization in compliance with rules and regulations. Attendees will learn how to avoid eyewash-related regulatory compliance issues, how to perform a risk assessment to determine when an eyewash station is necessary, and what type of eyewash station they need.

At the conclusion of this program, participants will be able to:

  • Avoid eyewash-related regulatory compliance issues
  • Perform a risk assessment to determine when an eyewash station is needed
  • Identify what type of eyewash station is needed
  • Properly maintain eyewash stations

Presented on:
Thursday, May 31, 2018
1:00-2:30 p.m. ET

Presented by:
John R. Rosing, MHA, FACHE

Level of Program:

Intermediate

To register or get more information, please visit the event page at HCMarketplace.com.