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IOM
To Assess Rural Health
Quality IOM
To Assess Rural Health
Quality The
Department of Health
and Human Services
has requested that
the Institute of Medicine
establish a committee
to provide an independent,
unbiased assessment
of the quality of health
care in rural America.
The
committee will develop
a conceptual framework
for a core set of services
and the essential infrastructure
necessary to deliver
those services to rural
communities. The
committee will also
recommend priority
objectives and identify
changes in policies
and programs–-including
payment policies and
the information and
communication technology
infrastructure—needed
to advance the identified
objectives. The
committee will consider
implications for federal
programs and policy
and recommend an agenda
for quality improvement
in rural settings,
identifying the performance
characteristics that
21st century community
rural health systems
should meet. As
a major part of the
study the committee
will convene a large
day-and-a-half workshop
in addition to three
committee meetings.
The discussions at
the workshop will focus
on key characteristics
unique to rural environments
and map out characteristics
that a model rural
community health system
should meet in terms
of care delivery, payment,
quality monitoring,
reporting, IT infrastructure,
and other relevant
areas. The
sponsors of the study
are the Health Resources
and Services Administration
(HRSA); Agency for
Healthcare Research
and Quality (AHRQ);
Substance Abuse and
Mental Health Services
Administration (SAMHSA);
and the W.K. Kellogg
Foundation. The committee
is expected to issue
a final report in late
2004. For
more information: http://www.iom.edu/project.asp?id=13989 RAND
To Study IT Impact
on Health Care RAND
Health is conducting
a study to determine
how the application
of information technology
to health care settings
may affect patient
care and cost saving. Managed
Care Weekly Digest
reports that the study
also will identify
the barriers to widespread
adoption of health
care IT and recommend
government policies
and other strategies
to increase the use
of information technology. By
examining medical facilities
that have implemented
IT and looking at past
research on the potential
of health care IT,
RAND will devise scenarios
to measure the possible
value of the systems,
Managed Care Weekly
Digest reports.
Companies
such as Cerner, Johnson
& Johnson, Xerox,
General Electric and
Hewlett-Packard will
help fund the study. "We
need to quantify, where
we can, what the true
value of increased
automation would be,"
said Dr. David Lawrence,
head of RAND’s steering
committee and former
CEO of Kaiser Permanente.
"This study will
help us determine if
the current system
has the right resource
allocations."
Another
recent RAND study found
that doctors only follow
about half of recommended
medical guidelines
and called for the
adoption of electronic
medical records and
clinical decision support
to improve care. Hospital
Quality Initiative
Gathers Momentum
All
14 general acute care
hospitals in Vermont
have pledged to take
part in the hospital
Quality Initiative,
making Vermont the
fourth state to achieve
100% participation
by eligible hospitals.
The
Vermont Association
of Hospitals and Health
Systems is the latest
of 45 state hospital
associations to endorse
the national hospital
Quality Initiative—a
joint voluntary effort
by the American Hospital
Association, the Federation
of American Hospitals,
and the Association
of American Medical
Colleges. Close
to 1600 hospitals nationwide
have agreed to take
part in the initiative
by publicly reporting
their performance data
on 10 clinical measures
for heart attack, heart
failure and pneumonia.
Data will be posted
periodically to the
Centers for Medicare
& Medicaid Services
web site, with the
first installment expected
later this month. Health
care professionals
are expected to be
the primary audience
for data posted to
the cms.hhs.gov web
site. A consumer-friendly
site, Hospital Compare,
is scheduled to be
launched on the Medicare.gov
site next year. Connecticut,
Rhode Island and Maryland
were the first three
states to reach 100%
hospital participation.
For more on the Quality
Initiative, go to www.aha.org
and click on the Quality
Initiative icon. Study:
African-American Women
Get Less Treatment
For Heart Disease The
American Heart Association
journal, Circulation,
reports in a study
that black women are
twice as likely as
white women to suffer
heart attacks and deaths
from heart disease.
The
gap is partly because
black women have more
severe heart disease
and risk factors such
as high cholesterol
and high blood pressure,
the study said. The
study was less clear
about why black women
receive less care for
the disease. The
four-year study, led
by Ashish K. Jha, a
fellow in general medicine
at Brigham and Women's
Hospital in Boston
and the Harvard School
of Health, looked at
2,699 women from 20
medical centers nationwide.
Eight percent of the
women were black. Researchers
found that the black
women had higher rates
of blood pressure,
diabetes and high cholesterol—all
risk factors that lead
to heart disease and
can be treated with
medicine. About
56 percent of the black
women had acceptable
blood pressure, compared
with 63 percent for
white women. Black
women had acceptable
cholesterol levels
30 percent of the time,
white women 38 percent
of the time. "Those
differences may not
seem large, but given
the fact that black
women are at such an
increased risk, treatment
should be more aggressive,''
Jha said. Black
women were 10 percent
less likely to get
aspirin and 27 percent
less likely to get
cholesterol-lowering
statins. Black women,
however, got more higher-priced
drugs, such ACE inhibitors
and calcium channel
blockers. Researchers
could not pinpoint
why black women were
getting less treatment,
but considered economic
differences and doctor
bias as possible factors. William
S. Weintraub and Viola
Vaccarina, professors
at Emory University
in Atlanta, said in
an editorial that accompanied
the report that more
research is necessary
to understand the disparities
and close the gap. Treatment
For AMI: Europe And
US Differ An
international study
published in the European
Heart Journal found
that some hospitals
and some countries
introduced new heart
attack therapies very
swiftly and others
only slowly, despite
strong evidence and
guidelines about their
effectiveness.
The
study checked what
happened to 12,666
patients with "acute
coronary events" in
developed countries
in Europe, North and
South America, and
Australia and New Zealand.
It
found, for example,
that the chances of
having balloon angioplasty
and stenting for a
heart attack was 40%
in the United States,
35% in Europe, 34%
in Brazil and Argentina,
and 25% in Australia,
New Zealand and Canada.
The
study also found wide
geographical variations
in prescribing patterns
for new anti-clot medicines
known as glycoprotein
llb/llla inhibitors.
In 2001, 52% of heart
attack patients in
the US received this
therapy compared with
27% of patients in
European hospitals
and 20% of patients
in Australia, Canada
and Brazil. Second-generation
heparin for blood thinning
was used in 63 percent
of heart attack patients
in Europe but in only
19 percent of patients
in the United States.
Authors
of the study concluded
that local factors,
such as national health
care policies in certain
countries and the availability
of resources, appear
to have a profound
influence on the extent
and time taken to adopt
therapies. Grants
Awarded To Fight "Unhealthy
Behavior" The
Agency for Healthcare
Research and Quality
(AHRQ) and the Robert
Wood Johnson Foundation
have awarded the first
round of research grants
to develop "effective,
practical strategies
that primary care providers
can use to help Americans
change their unhealthy
behaviors." The
research grants are
for 16 months, and
each grant is for $125,000.
The first round of
grants totals $2.1
million. Seventeen
primary care, practice-based
research networks,
which affiliate with
each other to improve
health care quality
through research, received
grants to design and
test innovative projects
to help primary care
providers. Each
grant project must
identify strategies
that can be applied
in routine primary
care practice and address
at least two risky
behaviors that affect
health care. "We
must bring the power
of primary care to
help Americans reduce
unhealthy behaviors
and improve their overall
health," Carolyn Clancy
director of AHRQ, said
in a news release.
"This is a major priority
for HHS Secretary Tommy
G. Thompson, and this
partnership with RWJF
will result in evidence-based
information and tools
that will help achieve
this critical goal."
The
grants are awarded
through Prescription
for Health, a five-year
initiative funded by
The Robert Wood Johnson
Foundation in collaboration
with AHRQ. Under
this initiative, primary
care practice-based
research networks are
developing strategies
for promoting healthy
behaviors among patients
in their practices
that can be easily
adopted by other primary
care practices. The
initiative targets
four health risk behaviors:
sedentary lifestyle,
unhealthy diet, tobacco
use, and risky drinking.
Grantees
include the Dartmouth
COOP Project for its
effort to change doctors’
office practices to
improve health behaviors;
the Alabama Practice
Based Research network
for its work using
PDAs to guide patient
intervention related
to smoking and diet;
and the Colorado Reseach
network for efforts
to create doctors’
office cultures to
promote patient wellness. For
a full list of grantees
and projects: http://www.prescriptionforhealth.org. FACCT
Conference on Health
Care IT The
Markle Foundation and
FACCT – Foundation
for Accountability—are
sponsoring a one day
conference on the impact
of IT on health care:
Health Care’s Information
Revolution: Putting
People at the Center
of Progress. The
conference will introduce
rapid new developments
in health care information
systems; explain the
potential to improve
quality and safety;
identify potential
risks to privacy and
accuracy of personal
health information;
and define the
role of consumer organizations
in the health care
information revolution.
The
conference is scheduled
for Tuesday, October
14, 2003, at the Sheraton
National Hotel - Arlington,
VA. The conference
is free, but registration
is required. Contact
ablumklotz@facct.org
to register. Health
Legacy Partnership
Conference
The
4th Annual Health Legacy
Partnership Conference,
will be held on October
22nd at the Ronald
Reagan Building in
Washington, DC. The
theme of this year’s
conference is "Power
to Patients: Moving
to Consumer Controlled
Healthcare Decisions,"
with a special focus
on the work at CMS
on improving quality
of care. Speakers
include: Senator Bob
Dole; Senator George
Mitchell; Senator William
Frist, MD (invited);
Carolyn Clancy, MD,
Director of AHRQ; Secretary
Tommy Thompson (invited),
Sean Tunis, MD, Chief
Medical Officer at
CMS; Paul Ellwood,
MD, Founder-Jackson
Hole Group; David Kibbe,
MD, Director, Health
Information Technology
- American Academy
of Family Physicians;
Richard Smith, MD,
Editor-British Medical
Journal; Janet Marchibroda,
President- eHealth
Initiative; and Jack
Wennberg, MD, Director,
Center for the Evaluative
Clinical Sciences -
Dartmouth College. The
event is free. Register
at www.healthlegacy.org,
or call 305-576-4310. NPSF
Conference On Accountability
In Clinical Research Actor-director
Christopher Reeve will
open the Second Annual
Conference on Integrity
and Accountability
in Clinical
Research with an address
on the importance of
human subject safety
in clinical trials
and other research. Presented
by the National Patient
Safety Foundation (NPSF),
the conference opens
Nov. 2 at the Renaissance
Hotel in Washington
D.C. Designed
to help researchers
and their institutions
meet the standards
of integrity and accountability
expected of research
with human subjects,
the meeting will address
many of the issues
and recommendations
in the Institute of
Medicine’s 2002 report
on "Integrity
in Scientific Research:
Creating an Environment
that Promotes Responsible
Conduct" as they
relate to research
using human subjects. FDA
Commissioner Mark B.
McClellan, MD, PhD,
will deliver the closing
keynote Nov. 4. He
will focus on why human
subject privacy, autonomy
and safety are paramount
in clinical research,
and why integrity in
research is essential
to maintaining the
public’s trust. Plenary
session discussions
will include such issues
of concern as: Informed
Consent in Light of
Genetics and Patient
Privacy; Eliciting
Informed Consent with
Vulnerable Populations; Conflict
and Confluence of Interests
in Clinical Research;
Bioterrorism Research
and the Challenge of
Preserving Patients
Rights; Accreditation
and Certification:
Creating an Ethical
Climate for Research. For
more: www.researchsafety.org.  Home :: Inside AHQA :: For The Media :: Public Policy :: Advancing Quality :: Quality Connections :: SiteMap
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