NCQA says quality of U.S. healthcare stagnant

After a decade of improvement, The National Committee for Quality Assurance has said that during last year the quality of healthcare was at a standstill in its annual State of Healthcare Quality Report. The study also  found that there no links between higher spending and better healthcare outcomes. The quality data that the report is based off of was submitted by 979 health plans across the country that collectively cover 116 million Americans, which is a 9 percent increase over 2008. The health plans use the HEDIS measures, which stands for Healthcare Effectiveness Data and Information Set.

Some of the trouble spots from this year’s report include the following statistics:

• Only 46.4% of people taking anti-depressant drugs are monitored by their physicians;
• 34.1% of children prescribed medications for attention deficit hyperactivity disorder (ADHD) are seeing a doctor for follow-up care
• Half of patients previously hospitalized for mental illness see a physician for a follow-up visit
• 45.3% of people are receiving colon cancer screening at the appropriate age
• Only 42.6% of patients with alcohol or drug dependency are entering into treatment

There was also an increase in the overuse of medical imaging for back pain and breast cancer.

I think the most striking point to come out of the report is the NCQA’s estimation that if all health plans were able to perform at the level of the top 10 percent of plans, the U.S. would avoid up to 115,000 thousand deaths and save at least $12 billion in medical costs and lost productivity every year.

In light of this report, the NCQA asked Congress to include language about quality improvement in its final bill.

Does any of this surprise you? I was mostly shocked to hear that this was the first year that the report showed little change in quality improvement.

Mistake-proofing and its relation to process management

One of my colleagues at HealthLeaders Media, Cheryl Clark, wrote this columnyesterday about making things fail-proof–anything really. She starts out by giving the example of how her fancy refrigerator beeps when the doors have been open for too long, reminding owners to shut the doors. She used that analogy to draw some comparisons to many of the mistake-proofing devices in healthcare, and how we are now really are coming into the age of really predicting how an error might occur and designing systems better to prevent those errors.

I’ve been reading up a lot lately on process management and even when speaking with people in the healthcare industry, there seems to be a lot of momentum behind the Lean and Six Sigma, the notion of ridding our systems of waste if we truly want them to succeed–and be the easiest and most logical way of doing things. Designing processes so that they are “mistake-proof” certainly ties in.

I suggest reading her column, it’s a good one. Do you see a larger waste reduction and process improvement effort taking place at your facility?

Should physicians be required to take cultural competency courses?

 It’s widely reported that racial and ethnic minorities receive less comprehensive healthcare than white patients. Some states have tried to address this by requiring physicians to undergo cultural competency training. Both California and New Jersey require such training and Maryland strongly recommends it. Nine other states are considering requiring some sort of cultural competency training.

However, an article in this week’s American Medical News points out that many physicians are opposed to such legislation mainly because it’s another topic around which they have to be educated. California and New Jersey have taken different approaches to mandating cultural competency training. California requires continuing medical education (CME) courses to contain information that is culturally and clinically relevant. New Jersey requires a specific amount of CME credits that must be earned in courses around cultural content as defined by the state medical board.

Some physicians opposed to the increased amount of cultural competence training wonder when the CME requirements will end and say that some requirements may not line up with what is clinically relevant. On the flip side, other physicians who are for such requirements say that without these mandates, most physicians would ignore the topic completely.

What does your state require? Do you think topic-specific CME mandates such as cultural competence are necessary for physicians? What about other healthcare workers?

AHRQ adds health literacy questions to CAHPS data set

The Agency for Research and Healthcare Quality (AHRQ) has released a set of 29 questions to be added to the CAHPS (Consumer Assessment of Healthcare Providers and Systems) Clinician and Group Survey that address health literacy. The set of questions was created in conjunction with Healthy People 2010, a national health promotion and disease prevention initiative.  The questions touch on the following topics:

• Communication with doctors
• Communication about health problems and concerns
• Communication about medicines
• Communication about tests
• Communication about forms
• Disease self-management

Research shows that only 12% of adults are fully health literate. The AHRQ’s definition of health literacy  is “patients’ ability to obtain, process, and understand the basic health information and services they need to make appropriate health decisions.” In recent years there’s been a greater push to make it the part of the physician’s and clinical team’s responsibility to educate patients about their health issues. The questions were designed as an assessment tool to help clinicians measure if their efforts are paying off and patients are in fact becoming more health literate, and it was also designed to be a quality improvement tool.

To find the set of health literacy CAHPS questions, and more about them, click here. Do you think your facility would add these health literacy questions to its existing set of CAHPS questions?

Another reason to celebrate October: Next week is International Infection Prevention Week

The worldwide healthcare community will be observing International Infection Prevention Week (IIPW) next week, from October 18-24. The Association for Professionals in Infection Control and Epidemiology (APIC), which spearheads the effort in the U.S., is urging all states and Congress to recognize the week as a way of bringing attention to the work that infection preventionists do and the toll that infections take on patients in many healthcare settings.

The theme for IIPW 2009 is “Infection Prevention is Everyone’s Business.” In conjunction with this theme, APIC will be offering a couple of Webinars with special theme days during that week:

• Tuesday, October 20: Collaboration
• Wednesday, October 21: Hand hygiene
• Thursday, October 22: Surgical site infections/ operating room safety

Additionally, the group will announce the winner of the first annual Healthcare Administrator Award, which will be given to a healthcare executive who has demonstrated continuing support for infection prevention at his or her facility. The announcement, which kicks off the observance of IIPW, will take place at a ceremony on Friday, October 16, during a live Webcast at 1 pm Eastern time. Specific APIC chapters located in New York City, Dallas/Fort Worth, TX, and St. Paul/Minneapolis, MN, will be hosting their own satellite events in conjunction with Friday’s announcement.

Is your hospital doing anything to honor IIPW?

October celebrates Health Literacy Month, National Healthcare Quality Week

The month of October brings us two health-related events to celebrate: Health Literacy Month and National Healthcare Quality Week (October 18-24). Both events give healthcare workers and their organizations a chance to think about current practices and how to improve in the name of patient safety.

Health Literacy Month, which was started by Helen Osborne, MEd, OTR/L, a health literacy consultant, in 1999. This year’s theme is “Why Health Literacy Matters: Sharing Our Stories in Words, Pictures, and Sound” and is accompanied by an informative Web site (www.healthliteracymonth.org). Each day during the month of October a new health literacy “story” is added to the “stories section of the Web site. One of these highlights a couple of songs sung by Mache Seibel, MD, in honor of the month. You can find more of his songs at the Web site www.healthrock.com. Additionally, the Health Literacy site provides different resources and materials for the month.

National Healthcare Quality Week (NHQW) is being observed next week and the National Association for Healthcare Quality’s (NAHQ) Web sitecontains news about continuing education opportunities and events in honor of the week. The time is meant to highlight those healthcare workers whose quality work influences patient outcomes for the better. It also provides suggestions for ways that healthcare facilities can promote and publicize NHQW or any NHQW-related events being put on in the organization or larger community.

Are any of your facilities observing Health Literacy Month or National Healthcare Quality Week? What has your hospital done?

New Jersey hospital claims 9-minute ED wait time

How did Palisades Medical Center in North Bergen, NJ reduce its wait-time for the emergency department (ED) to nine minutes, down from one hour? A story in yesterday’s Chicago Tribune highlights Palisades for its plan to reduce patient wait times by reorganizing how patients are seen when they enter the ED. When a patient who doesn’t have severe injuries comes to the ED , he or she is treated by a rapid evaluation unit–a team of two nurses, a physician, and a technician–and triaged. This frees up the ED’s main staff members and equipment for more seriously injured patients. These less-severe patients add up to 60% of all patients treated at Palisades’ ED. Palisades Medical Center.

Nationwide, patients who visit the ED for treatment wait an average of 37 minutes just to be seen, nevermind treated. The biggest culprit for long wait times is the inability to find inpatient  beds for already admitted ED patients, which in turn makes it difficult to admit more patients to the ED.

You can find the article from the Chicago Tribune here.

Has your facility had to examine its ED admission process in the name of patient flow? Have you come up with any unique solutions to this issue?

One facility employs ’scribes’ to ease transition from paper to electronic records

Today’s USA Today has an interesting article about one hospital’s transition to an electronic system from using paper records. The University of Virginia Medical Center has been employing scribes to aid doctors in capturing the necessary information that comes out of a consult or appointment with a patient. The scribes follow physicians to these consults and use laptops to type notes into the electronic medical record (EMR). Then the physicians sign off that the information is correct after he or she has finished speaking with the patient. That way physicians can give all of their attention to their patients and don’t have to worry about filling in fields in the EMR.

Leah Binder, CEO of the Leapfrog Group, told the paper that this model may work for now at the facility, but she doubted it would see widespread adoption. This is because there’s a chance for mistakes to enter the patient’s record, even if physicians read over the record.

The article said this was the only facility in the country to use scribes during the paper-to-electronic switch. Have you ever heard of this idea? Has your hospital developed some other creative method for easing the transition?

The sleep factor: Do less tired physicians deliver safer care?

The debate on whether reducing the number of hours that graduate medical students can work consecutively, as well as per week, has had any effect on the safety of patient care continues, reports American Medical News. Last year the Institute of Medicine made even further recommendations for reducing the number of hours that residents can work, based on sleep science. Those suggestions have yet to be implemented. However, there is evidence both for and against further reducing the amount of hours that residents can work.

Since 2003, residents are allowed to work no more than 80 hours each work week. However, each time residents’ shifts are over, they must hand their patients off to new residents. More handoffs often lead to an increase in poor patient safety outcomes. However, tired residents also may not able to make appropriate decisions regarding patient care. Sleep deprivation affects each person differently. Additionally, it’s difficult to truly measure patient safety and what may affect it.

To read more from American Medical News, click here. Has your facility had any open discussions regarding resident hours?

The role of accountability in a culture of safety

Two well-known names in the patient safety field, Robert Wachter, MD, professor and associate chairman of the department of medicine at the University of California, San Francisco, and Peter Pronovost, MD, PhD, medical director for the Johns Hopkins Center for Innovation in Quality Patient Care, have published an article in the New England Journal of Medicine (NEJM) about the need to make accountability a larger part of the discussion when it comes to patient safety and a no-blame culture. The whole patient safety movement was set in motion ten years ago with the publication of the Institute of Medicine’s To Err is Humanreport. Wachter and Pronovost say that the industry has come a long way since then, and important steps have been taken in the name of patient safety.

However, it’s time to move past simply acknowledging that the majority of adverse events are the result of human factors, not malicious intent, say Wachter and Pronovost. It’s time that hospital leaders take responsibility for those staff members who routinely fail to perform simple safety checks and actions that would prevent adverse events from occurring. In Wachter’s most recent blog post on his blog “Wachter’s World”, he discusses how he and Pronovost are expecting a backlash from the field for asking for more accountability in the patient safety world. It is time to ask for more from leaders and caregivers to do simple things like handwashing or using a checklist before surgery, though. If the steps have been taken to change how processes work and to emphasize a culture that acknowledges that most errors are systems-based accidents, and those errors continue to occur, it is time to move on and incorporate some amount of accountability into the system, say Wachter and Pronovost.

You can find the NEJM excerpt here, but Wachter’s posts a good summary on his blog if you don’ t have full access to the journal.

This is a topic that touches many emotions, and you may have differing opinions on the topic. I’d welcome any comments on the blog post or how your hospital has attempted to address the culture of safety.