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Study
Rates Patients’ Chances
Of Getting Optimal
Care At 50-50 CDC
Predicts One In Three
Americans Will Get
Diabetes More
States Line Up Behind
Hospital Quality
Initiative JCAHO
Completes Standards
Review, Debuts Standards
Online Health
IT Groups Urge Feds
To Finance Health
IT Infrastructure Study:
IT Can Improve Patient
Safety Report
Highlights Keys To
Launching CPOE In
Community Hospitals California
Patients Rate Experience
Of Care In Hospitals Business
Group Announces New
Institute To Cut
The Fat IOM
Quality Summit Moved
Back From October
To January 2004 IHI
Calls To Focus on
Priority Areas For
Improving Quality Medicare
beneficiaries and American
taxpayers cannot afford
for the Medicare payment
system to remain neutral
towards quality, the
Medicare Payment Advisory
Commission said in
a new report. Calling
for “urgent” change,
MedPAC recommended
that Medicare pay providers
differently based on
quality and implement
other payment structures
to promote quality
across settings, where
some of the most important
quality problems occur.
The Centers for Medicare
and Medicaid Services
should start with two
settings, Medicare+Choice
plans and inpatient
rehabilitation facilities,
the report said, because
these settings offer
reliable measures and
standardized data collection. “(CMS’)
public reporting initiative
has provided a strong
impetus for quality
improvement for M+C
plans, dialysis facilities,
nursing homes, and
most recently, home
health agencies. The
Commission strongly
supports these efforts
to measure and improve
care and believes CMS
should continue to
expand public reporting
of provider quality
and use of the Quality
Improvement Organizations
s to assist providers
in improving quality,” the
report said. The
report noted with concern
the persistence of
large variations in
local per beneficiary
fee-for service spending,
and the possibility
that these may be the
result of beneficiaries
in low-expenditure
areas not getting the
care they need or inefficiency
in high-expenditure
areas. MedPAC
reports to Congress
each March and June
on the recommendations
made by the commissioners
at their meetings since
the last report. The
reports also address
issues for which there
have been no recommendations. For
more info, www.medpac.gov. Study
Rates Patients’ Chances
Of Getting Optimal
Care At 50-50 Americans
face a slightly better
than 50-50 chance that
their medical problems
will be addressed the
right way when they
visit a doctor’s office
or a hospital, according
to a new report published
in the New England
Journal of Medicine. Recommended
best practices were
followed about two-thirds
of the time in diagnostic
testing, prescribing
drugs for acute and
chronic illnesses,
and monitoring patients’ long-term
health, the report
said. There is only
a 1-in-5 chance that
a patient will receive
appropriate counseling
and health education. Quality
of treatment differed
according to disease,
with the best performances
seen in breast cancer,
certain forms of heart
disease, and low back
pain. For pneumonia,
bladder infections,
diabetes and peptic
ulcers, however, fewer
than half of the recommended
best practices were
followed. Usually,
the report said, physicians
and nurses did not
do or ask enough. In
other conditions, such
as migraine headaches,
patients were over-treated. The
study adds another
chapter to the expanding
body of research that
shows a huge gap between
what is known to be
good care and what
is provided by medical
practitioners. “The
bad news is just how
bad the results are.
The good news is that
there is a lot of work
going on in this area,” Carolyn
M. Clancy, director
of the Agency for Healthcare
Research and Quality,
told the Washington
Post. The
study built on a previous
survey that asked 20,000
randomly chosen adults
in 12 metropolitan
areas where and how
they received medical
care. They were asked
to name their physicians
and consent to the
release of their medical
records for the previous
two years. A brief
medical history was
also taken over the
phone. Ultimately,
copies of hospital
charts and clinic notes
from about 40% of the
people surveyed were
used. Twenty
nurses then reviewed
the records, looking
for evidence that appropriate
clinical interventions—chosen
by experts—were done
or not. The
percentage of the time
that patients got the
recommended treatment
for breast cancer was
76%; coronary artery
disease, 68%; hypertension,
65%; congestive heart
failure, 64%; and diabetes,
45%. The
researchers also looked
at performance based
on general type of
intervention. Medication
choices followed recommended
practices 69% of the
time; immunizations,
66%; physical examination,
63%; and lab testing,
62%. However, physicians
asked key questions
while getting the medical
history for the patient
43% of the time. Adequate
counseling and teaching
were done 18% of the
time. The survey also
found that only 61%
of people with heart
attacks received aspirin. CDC
Predicts One In Three
Americans Will Get
Diabetes The
Centers for Disease
Control and Prevention
has predicted that
one in three Americans
born in 2000 will develop
diabetes during their
lifetime—including
about 29 million who
are diagnosed and 10
million undiagnosed
cases within 50 years. CDC
officials said its
forecast, presented
at the American Diabetes
Association meeting,
increases the urgency
of finding strategies
to avoid diabetes complications,
or prevent the disease
altogether with various
combinations of diet,
exercise and drugs,
the Wall Street
Journal reported. A
study of youth at risk
for Type 1 diabetes
failed to prevent the
condition with oral
insulin treatment,
but other studies showed
that intensive blood-sugar
control and lifestyle
change produced striking
and durable benefits. One
study presented at
the conference showed
lifetime risk for American
males born in 2000
is 33%, while women
and Hispanic-Americans
face grimmer odds—as
high as a 50% risk
of diabetes. There
was some good news
for people with Type
2 diabetes that came
from a study called
the Diabetes Prevention
Program performed by
David M. Nathan, a
professor at Harvard
Medical School and
director of the diabetes
program at Massachusetts
General Hospital, Boston.
It showed a program
of diet and exercise
lowered classic cardiovascular
risk factors of high
blood pressure and
harmful blood fats
called triglycerides
more than did the drug
metformin. Previously,
the study proved modest
weight loss and 30
minutes of daily walking
cut the risk of developing
Type 2 diabetes by
58%, while metformin
cut it by 31%. In the
new analysis, the most
potent benefit, weight
loss, also was toughest
to maintain. After
losing an average of
7% of their bodyweight,
participants had gained
some of it back four
years after the end
of the program. On
average, though, they
maintained a 4% to
5% weight loss. For
more info, www.diabetes.org. More
States Line Up Behind
Hospital Quality
Initiative Rhode
Island and Connecticut
are reporting 100%
participation in The
Quality Initiative:
A Public Resource on
Hospital Performance,
and Virginia has joined
a growing number of
state hospital associations
endorsing the initiative,
according to the American
Hospital Association. The
voluntary initiative
asks hospitals to make
performance data already
being collected as
part of hospital accreditation
available to the public.
Each of Connecticut’s
30 hospitals and Rhode
Island’s 10 general
adult acute care hospitals
have signed up to take
part. “We
are very pleased and
proud to learn that
Connecticut is the
first state in the
nation to have all
of its hospitals signed
on to participate in
voluntary reporting
program,” said Marcia
Petrillo, CEO of Qualidigm,
the Quality Improvement
Organization in Connecticut. “It
is the result of a
collaborative effort
among the state hospital
association, Qualidgm,
and the state department
of public health. The
hospital association
led this exceptional
effort, and we provided
ongoing support to
make it happen.” The
board of directors
of the Virginia Hospital
and Healthcare Association
unanimously adopted
a resolution supporting
the Quality Initiative
and urging member hospitals
to participate, AHA
reported. As
of June 19, AHA said
other state hospital
associations to formally
endorse the initiative
include CA, CO, CT,
DE, DC, GA, ID, IL,
KS, LA, MA, MI, MO,
NE, NH, NJ, NC, RI,
SC, TN, WA, WV, and
WI. For
more info, www.aha.org. JCAHO
Completes Standards
Review, Debuts Standards
Online The
Joint Commission on
Accreditation of Healthcare
Organizations has unveiled
revised accreditation
standards that sharpen
the focus on processes
critical to achieving
safe, high quality
care, it said. These
standards become effective
Jan. 1, 2004 for hospitals,
home care organizations,
ambulatory care clinics,
behavioral health care
organizations, and
laboratories and long-term
care organizations. The
2004 standards are
posted on the JCAHO
website (www.jcaho.org),
so organizations can
access the standards
prior to publication
of the official accreditation
manuals this fall.
A comparison between
old standards and new
is also available. The
new standards are designed
to reduce the paperwork
and documentation burden
of the accreditation
process and increase
its focus on patient
safety and health care
quality. JCAHO said
the Standards Review
Project: Health
IT Groups Urge
Feds To Finance
Health IT Infrastructure The
National Alliance
for Health Information
Technology announced
its support for a
Health Technology
Center (HealthTech)
plan to
encourage the
federal government
to take the lead
in financing the
health IT infrastructure. HealthTech’s proposal
calls for the federal
government to make
an initial investment
in capital that would
be allocated to each
of the states. The
states would then transfer
the funds to independent
nonprofits responsible
for deciding which
projects should receive
loan financing or grant
funding, and on what
terms, said HealthTech
Executive Director
and Founder Dr. Molly
Joel Coye. The
Alliance consists
of health care leaders
seeking to improve
the safety, quality
and efficiency of
care through information
technology systems
that require voluntary
IT standards, organizational
changes within most
health care delivery
systems, and public
policy reforms, it
said. For
more info, www.healthtech.org. Study:
IT Can Improve Patient
Safety An
article in last week’s New
England Journal of
Medicine said that
information technology
can improve patient
safety by reducing
medical errors, enhancing
communication, and
providing help with
decisions. The
report noted, however,
that obstacles such
as the absence of standards
and limited funding
stand in the way of
IT development and
implementation. An
important way to improve
safety is to provide
greater access to drug
and reference information
through use of computers
and handheld devices,
the article said. Technology
could help alleviate
staff shortages and
detect early warning
signs that a patient
is in danger, it said. For
more info, www.nejm.org. Report
Highlights Keys To
Launching CPOE In
Community Hospitals Community
hospitals in California
are implementing computerized
physician order entry
and gaining physician
participation to close
the gaps in safety
and quality, according
to a new report by
the California HealthCare
Foundation and First
Consulting Group. The
study is based on interviews
with key staff at 10
community hospitals
that have started CPOE,
and with CPOE software
vendors. To
be successful, the
study said physicians
and project leaders
cited the need for
the organization’s
CEO and medical, nursing,
and pharmacy leadership
to be on board. Other
keys to success included
sufficient resources;
a collaborative spirit;
hospital and physician
experience with computer
systems; a physician
champion; and cohesive
medical staff. For
more info, www.chcf.org. California
Patients Rate Experience
Of Care In Hospitals Californians
can view what patients
think of the care they
received in hospitals
all over the state
via a Web site sponsored
by the California HealthCare
Foundation. Nearly
35,000 people who had
spent at least one
night in a participating
hospital responded
to the second statewide
survey, cosponsored
by the California Institute
for Health Systems
Performance. The effort
drew information on
61% more hospitals
than the first survey
in 2001. A total of
181 hospitals, representing
more than half of all
beds, participated. Statewide,
about one-quarter of
hospitals received
an above average rating
for overall performance,
18% rated below average,
and 57% were rated
average. For
more info, www.chcf.org. Business
Group Announces New
Institute To Cut
The Fat The
Washington Business
Group on Health has
launched the Institute
on the Costs and Health
Effects of Obesity
to help corporate America
reduce the impact of
obesity and weight-related
conditions in the workplace. The
Institute, which includes
leading corporations
and federal health
agencies, will explore
the epidemic of obesity,
propose solutions and
strategies, and serve
as a catalyst for change,
WBGH said. The
Institute will serve
as a resource for large
employers on the health
and cost repercussions
of obesity and related
chronic conditions.
Additionally, the group
will identify effective
strategies to decrease
the incidence of obesity
among U.S. workers
and will develop and
disseminate clear messages
that stress obesity’s
preventable nature
as well as its role
in physical and mental
health. The
Institute released
its first product,
an Employer Toolkit
report on weight management
that offers ways to
support employees’ desires
to have healthier lifestyles.
Additional Institute
projects and initiatives
planned for the next
two years include a
national weight awareness
initiative, issue briefs,
an online resource
center, and a Corporate
Summit that will bring
large employers together
to discuss obesity-related
challenges and share
effective solutions
and strategies. For
more info, www.wbgh.com. IOM
Quality Summit Moved
Back From October
To January 2004 The
IOM committee working
on a invitation-only
summit to address health
care quality concerns
highlighted in the “Crossing
the Quality Chasm” report
has pushed back the
meeting until January
2004. This
summit is a follow-up
to the IOM report on
the 20 priority areas
for quality improvement.
The first of a planned
series, this summit
will focus on diabetes,
asthma, pain control
in end of life care,
heart disease, and
major depression. After
the summit, the advisory
committee will produce
a final report highlighting
the strategies and
action plans developed. IHI
Calls To Focus on
Priority Areas For
Improving Quality The
Institute for Healthcare
Improvement will host
seven 90-minute audio
conference calls, beginning
July 15, featuring
IOM staff and committee
members associated
with the “Priority
Areas” report and the
upcoming Quality Chasm
Summit. Participants
will include: IHI
said an entire team
from an organization
can listen to the audio
conference for $2,295. For
more info, www.ihi.org/conferences/callstoaction.  Home :: Inside AHQA :: For The Media :: Public Policy :: Advancing Quality :: Quality Connections :: SiteMap
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