All Entries Tagged With: "quality improvement"
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.
RWJF announces $1.5 million in grants for patient safety projects
The Robert Woods Johnson Foundation (RWJF) announced it is awarding $1.5 million to different patient safety research projects throughout the country. The grants are being given through the RWJF’s Interdisciplinary Nursing Quality Research Initiative (INQRI) and will run through the next two years. The grants specifically are being awarded to five teams from various institutions, each receiving $300,000 to study how improved nursing care can positively affect patient safety.
These grants have been awarded in an effort to bridge the gap on scientific research done to study the relationship between what nurses do on a daily basis and patient care. Since 2005 INQRI teams have undertaken numerous patient safety studies and these new studies will continue to study how nursing care can affect the quality of care provided at a hospital.
You can find more information about the grantees by clicking here.
IHI launches online component of Improvement Map
Earlier this week, the Institute for Healthcare Improvement (IHI) launched the online tool component of its Improvement Map, which was announced at IHI’s December 2008 National Forum (and I’m sure many of you have waiting in anticipation since then). The Improvement Map is a collection of processes that ultimately determine how a healthcare organization functions. The processes are broken down by domain (type of processes) and by aim (corresponding with the Institute of Medicine’s six aims for improvement). Users also have the option of customizing the Improvement Map so only the processes in which they are most interested appear when they log on.
This comprehensive resource looks to be an asset to the field. Many of you reading may be involved with one or many of the IHI’s existing initiatives and I’m sure you’ll find this new online component of real value. Not only does the Improvement Map offer guidance on many specific topics, it also provides resources, information, and points users in the direction even more information outside of its confines if you so desire.
Joint Commission launches Center for Transforming Healthcare
The Joint Commission announced a new effort to address the nation’s biggest issues in terms of quality care and patient safety yesterday when it launched the Center for Transforming Healthcare. At the crux of the Center’s approach to improving patient safety is using Lean and Six Sigma to improve processes and address some of the challenges facing caregivers and patients. It hopes to offer specific guidance on how to solve issues like preventing healthcare-acquired infection, ensuring medication safety, coordinating safe patient handoffs, and focusing on surgical safety.
This not-for-profit has coordinated with some of the nation’s leading health systems to work on some of the above mentioned issues. You can find the full list by clicking here.
I did find it useful to know that starting midway through 2010, hospitals that are Joint Commission-accredited will be able to utilize an application on the site that will work with each facility individually to develop custom solutions.
Announcing the winner of the Patient Safety Monitor Contest!
The month-long Patient Safety Monitor Contest has come to a close, and I’d like to thank everyone who sent in entries, read the creative ideas of the week, and commented on the blog. Although there were many great ideas entered into the contest, our panel of judges at HCPro has chosen Abington Memorial Hospital’s (AMH) “Patient Safety First” education program as the winner!
Entered by Robert C. Giannini, NHA, safety/quality specialist at AMH in Abington, PA, the program includes a month-by-month effort to focus on a different patient safety topic each month on a hospital-wide level. It’s an education campaign to train all staff members about the patient safety issues facing hospitals today.
In Robert’s words:
The objective of this monthly program is to promote communication (“a behavior a month”) and hospital-wide alignment in our efforts to establish and maintain a safe and reliable healthcare culture.
The program meshes the Joint Commission’s National Patient Safety Goals for 2009 with the hospital’s own internal goals. Part of the effort involves safety coaches, who are frontline caregivers that make it a goal to involve all of their fellow staff members in the theme of the month. This has been such a success at AMH partly because staff members know that the effort is not going away. It’s publicized in some of the hospital’s newsletters and materials are posted throughout the facility to remind staff members the focus of the month.
For 2009, AMH developed a 12-month Patient Safety First schedule. The focus in January was on hand hygiene. The hospital developed patient education materials to alert patients that handwashing was a focus that month and asked them to be a partner in their own safe care. Additionally, those in charge of the campaign created separate materials for staff members, reminding them that January’s patient safety topic was performing hand hygiene before and after contact with patients or the hospital environment.
Thanks for entering, Robert! As the winner of the contest, Robert receives a complimentary copy of the Patient Safety Officer’s Handbook.
AHRQ says that more patients are leaving against medical advice
More news from the AHRQ–this time, however, patients may be acting as a threat to themselves. An August report from the Healthcare Cost and Utilization Project says that between 1997 and 2007, the number of patients who left the hospital against medical advice rose 39%. Although the 368,000 people who did leave against medical advice represent only 1.2% of all hospital patients, the readmission rate for these patients is significantly higher than for the rest of the patient population—not to mention these patients immediately put themselves at high medical risk.
Patients leave against medical advice for many reasons. The report makes it clear that it’s necessary to get to the bottom of why patients might leave against medical advice, because that holds the key to making sure they complete their hospital stays in the future. Often the reasons may be related to external factors, like financial obligations or family emergencies versus perception of poor treatment, but it’s important to address these external factors as well in order to provide the safest care.
Have you had any experience with patients who left against medical advice? How have you addressed this issue as a medical staff?
NYTimes op-ed discusses how to lower costs, increase quality in American healthcare
To boost quality and lower healthcare costs, it’s not necessary for the American healthcare system to adopt a foreign model, but rather to look to successful models that exist within the U.S. That’s the message from an op-ed piece that appeared this weekend in the New York Times, written by Atul Gawande, Donald Berwick, Elliot Fisher and Mark McClellan. These four healthcare leaders invited teams from ten regions of the country that were considered “high performing” to meet and discuss why residents in their areas received higher quality healthcare at a lower cost than the rest of the nation.
Many of the teams interviewed used methods such as employing physicians at hospitals, studying the overuse of imaging technologies, and focusing on collaboration with various players in the healthcare community. The initiative, titled “How did they do that?” is a joint effort from the Institute for Healthcare Improvement, The Dartmouth Institute for Health Policy and Clinical Practice, the Brigham and Women’s Center for Surgery and Public Health, the Engelberg Center for Health Care Reform at Brookings, and Re>Think Health, an initiative of the Fannie E. Rippel Foundation. You can find out more about the initiative and the meeting with the healthcare leaders and regional teams listed above by clicking here.
Patient safety-related cost savings not always easy to calculate
As hospitals face deeper payment cuts from the federal government, many are considering new methods to cut costs. Indeed, many hospitals have already cut staff members and scaled back existing expansion projects. President Obama has suggested penalizing hospitals for poor rehospitalization rates—those facilities that have higher rates of patients returning for care once they have been discharged.
Unsurprisingly, patient safety officers and quality improvement managers have had to talk the business talk more often this year, often being asked to make a sound financial argument for new quality initiatives.
However, calculating savings from newly implemented quality initiatives or staying the course with sound evidence-based practice is not always easy. This article from American Medical News highlights some ways that hospitals are struggling to quantify any savings they have seen. It’s true that taking part in the important quality projects often does save costs on some end, but that money might not directly go to the bottom line. Click here to read more from American Medical News.
Have you had to “quantify” any patient safety or quality initiatives this year that you or your department has taken part in?
Hospital Compare Web site adds new readmission data
Yesterday the Hospital Quality Alliance announced the addition of new data available on the CMS Hospital Compare Web site. The general public, as well as the medical field, can now log on and compare hospital readmission rates for Medicare patients suffering from a heart attack, heart failure, and pneumonia. The data show readmissions within 30 days of discharge from any facility, even if patients do not return to the hospital from which they originally were cared for. This data, collected from Medicare billing records from July 2005 through June 2008, will provide consumers the ability to make a more educated decision about where they want to seek care.
Readmission rates have become a focus of many prominent groups of late. A study published in the New England Journal of Medicine earlier this year revealed that 20% of Medicare patients are readmitted to the hospital within a month of being discharged, and 34% are readmitted within three months (see an earlier blog post on this announcement). The CMS launched a pilot project earlier this year to reduce readmissions by working with 14 Quality Improvement Organizations (QIO). The IHI has launched an initiative called STAAR, which stands for State Action on Avoidable Rehospitalizations.
Additionally, the Obama administration is eyeing rehospitalizations as something that could be financially penalized. Rehospitalizations represent a significant amount of money spent (an extra $17.4 billion in 2004) and an example of how the current health system fails at treating patients in all areas of life and paying particular attention to transitions in care.
Those who log on will find that hospitals’ readmission rates for the conditions listed above are rated as “no different than the U.S. national rate,” “better than the U.S. national rate” or “worse than the U.S. national rate”. Users then have the option to view specific percentages in graphs and tables for the hospitals they have selected to compare.
“”America’s hospitals have long been committed to improving patient care and welcome the
opportunity to use all of the information on the Hospital Compare Web site to gain new insights
into how to strengthen quality,” said Rich Umbdenstock, president and CEO of the American Hospital Association. “In particular, the new information on readmission rates gives hospitals a broad look at how their patients receive care both inside a hospital and after they have been discharged. With the new information now in hand, hospitals will seek to understand why patients are readmitted and how some of those readmissions can be prevented through appropriate changes in care delivery.”
Any reaction to this latest release of quality information on the Hospital Compare Web site?
AHRQ releases “state snapshot” quality Web site
I saw this Wall Street Journal Health Blog posting about a resource from the Agency for Healthcare Research and Quality (AHRQ) that I thought readers of this blog might be interested in: State Snapshots. The AHRQ has culled data based on the 2008 National Healthcare Quality Report and broken that data down into state-specific information. Those interested in seeing how their own states stack up against the rest of the states in the country can do so by clicking here and finding specific states via the map of the country.
How does your state match up? Was it what you expected to see?
