Quality Update for April 17, 2003

VA Admits Deficiencies In Heart Care, Vows To Improve System Employers To Pay Incentives To Doctors Under ‘Bridges’ Program IOM Seeks Improved Workforce Training To Improve Quality Of Care Leapfrog Group Revises Hospital Patient Safety Survey Measures Vanderbilt U. Uses Technology To Improve Diabetes Treatment WI Bill Would Reward Hospitals That Invest In Computer Systems Report: Aspirin Linked To Lower Risk Of Breast Cancer VA Admits Deficiencies In Heart Care, Vows To Improve System The Veterans Affairs Department has conceded it has not provided care for heart attack patients as well as it should and laid out steps to improve. According to the study, heart patients treated at VA hospitals in the late 1990s had consistently higher mortality rates than comparable patients treated at non-VA institutions. A larger proportion of the veterans died in the first month after suffering a heart attack, and a larger proportion of the survivors died over the next three years, according to a new study. The study also found that VA patients undergo cardiac catheterization less often than patients treated in non-VA hospitals. VA patients had only about half the likelihood of undergoing angioplasty or bypass surgery, two procedures that can often extend life. The department, which provides medical care for nearly 5 million veterans a year, commissioned the study, and Veterans Affairs Secretary Anthony Principi said the results were troubling and required immediate action. Principi outlined a number of changes he is ordering for the department’s 162 hospitals. These include a better system for quickly moving VA heart attack patients to hospitals offering a full menu of cardiac services should they be at a VA hospital that lacks them. Principi also said the department will make greater efforts to ensure VA doctors follow clinical guidelines for treating heart attack patients; will more closely monitor indicators of optimal care; and will appoint a panel of experts to oversee its progress. The department will also establish an ongoing system for tracking clinical outcomes of heart patients over time. The department’s announcement was notable because the VA medical system has become a national model for quality improvement and patient safety. Also of note, the VA made no attempt to deny the latest findings, despite recent studies showing that veterans get above average care in many quality measures. For more info, www.va.gov. Back to top Employers To Pay Incentives To Doctors Under ‘Bridges’ Program Some businesses want to improve the health of their employees with an initiative that gives doctors financial incentives for boosting patient care. A coalition of physicians, health plans and employers have joined together for the initiative, called "Bridges for Excellence." The program will begin in select cities and focus on diabetes care, cardiovascular care, and patient care management systems. Under the program, participating companies will pay doctors thousands of dollars in bonuses for each worker whose care improves. For instance, a participating physician would get $100 yearly for each diabetic person whose blood pressure, blood sugar and lipid levels are sufficiently measured and controlled. The initiative also will help companies. Organizers said that an employee suffering from poorly controlled diabetes typically will miss about 12 days of work per year due to the illness, compared to just two days for diabetics who illness is controlled. The physicians who improve care also will be highlighted in provider directories given to employees and their families. Employers participating in the program include General Electric, Ford Motor Company, UPS, Procter and Gamble, Cincinnati Children’s Hospital Medical Center, Humana and Verizon. "Rewarding physicians for improving the quality of health care they give just makes sense," said CMS Administrator Thomas A. Scully in a statement on the initiative. For more info, www.bridgestoexcellence.org. Back to top IOM Seeks Improved Workforce Training To Improve Quality Of Care Changes are needed in the education of doctors, nurses, and other health professionals to improve patient safety and quality of care, according to a new report by the Institute of Medicine. For example, IOM said licensing boards should require doctors, nurses, and other health workers to demonstrate their clinical skills and understanding of medical advances, rather than let the professionals simply take a class and pay a fee to renew a license. The report said "five core competencies" should be adopted for programs that train health professionals: the abilities to deliver patient-centered care, to work as a member of an interdisciplinary team, to engage in evidence-based practice, to apply quality improvement approaches, and to use information technology. In addition, the report, Health Professions Education: A Bridge to Quality, said licensing and accreditation organizations should ensure that students and working professionals develop and maintain proficiency in these areas. Patient-centered care involves identifying and respecting patients’ differences, values, and preferences, and includes relief of pain and suffering, the report said. For quality improvement, health professionals should identify hazards and errors, measure the quality of care, and test interventions to change processes and systems that improve quality. The fifth core element, in the area of "informatics," involves use of IT to mitigate errors and manage knowledge, the report said. Among specific recommendations in the report is that the Centers for Medicare and Medicaid Services take the lead in funding experiments that will enable and create incentives for health professionals to integrate the interdisciplinary approach into educational or practice settings. This would be done through Medicare demonstrations projects, with the goal of providing a training ground for students and clinicians that incorporates the five core competencies. For more info, http://www.nationalacademies.org. Back to top Leapfrog Group Revises Hospital Patient Safety Survey Measures The Leagfrog Group has changed its voluntary Hospital Patient Safety Survey and recommended safety practices to provide more time for hospitals to adopt computerized physician order entry systems, broaden the definition of "intensivist" and include clinical process and outcome measures of quality. Leapfrog, a coalition of organizations that provide health care benefits, uses the survey to inform employers and the public about hospital performance on patient safety. The survey focuses on three sets of safety measures: computerized physician order entry, evidence-based hospital referral, and the use of critical care physicians known as intensivists. The evidence-based referral measures previously focused exclusively on volume measures of quality. For more info, www.leapfroggroup.org. Back to top Vanderbilt U. Uses Technology To Improve Diabetes Treatment Vanderbilt University Medical Center is changing the way it treats diabetes by expanding its use of the Internet to transmit digital photographs of patients’ eyes to centralized evaluation centers, where technicians look for evidence of disease. Vanderbilt has signed a contract with the Department of Veterans Affairs to provide services to at least 5,800 diabetic patients at the VA hospitals in Nashville and Murfreesboro, according to Vanderbilt Ophthalmic Imaging Center. Vanderbilt will place specialized cameras at both VA hospitals. It already has a camera at two public health clinics in Nashville and recently received a grant from the Frist Foundation for expansion to another clinic, hospital officials said. Photographs from those five locations will travel via Internet to Vanderbilt’s evaluation center, which operates in donated space in the BellSouth Tower in downtown Nashville. Other medical specialties, such as radiology, also have turned to filmless digital technology and the Internet in recent years. Hospitals, including VUMC and Centennial Medical Center in Nashville, have adopted filmless technology. Fore more info, www.mc.vanderbilt.edu. Back to top WI Bill Would Reward Hospitals That Invest In Computer Systems Saying that electronic records and computerized physician order systems will save health care dollars and improve patient safety, a Wisconsin state representative plans to introduce a bill that rewards hospitals for getting wired. State Rep. Sheldon Wasserman’s (D) bill would give a 1% state increase in Medicaid reimbursements to hospitals that invest in the new systems. Wasserman estimated the cost to the state would be about $2 million a year but said it would be well worth it in mistakes avoided, lives saved, and costs reduced. The systems are designed to reduce medical errors, allow doctors to track orders electronically, and warn physicians about dangerous drug interactions and redundant laboratory work, he said. Most Wisconsin hospitals lag behind when it comes to computerized systems including electronic medical records, Wasserman said, as hospitals still too often use paper records which can be confusing, misread or lost. Wasserman cited an Institute of Medicine 1999 report called "To Err Is Human," that concluded that as many as 98,000 deaths occur annually in U.S. hospitals as a direct result of medical errors. He said new technology, such as CPOE systems could cut mistakes by as much as 70% by catching errors medications are ordered. Back to top Report: Aspirin Linked To Lower Risk Of Breast Cancer Women can cut their risk of breast cancer by as much as half by regularly taking aspirin or ibuprofen, the nation’s largest women’s health study suggests. A cancer-preventing benefit was seen when women took normal doses of aspirin or ibuprofen at least three times a week. No benefit was seen with acetaminophen, the main ingredient in Tylenol, according to the report released by the American Association for Cancer Research. The new research involved more than 80,000 of the 162,000 women ages 50-79 in the federally funded Women’s Health Initiative. Experts say more study is needed to prove a benefit, but that taking such pain pills could be a simple preventive measure and one of the few things women can do to lower their odds of getting a disease that is the No. 2 cancer killer in women. For more info, www.aacr.org. Back to top

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