Quality Update for October 3, 2003

NACHC: Health Centers Help Reduce Racial Health Disparities Patient Safety Researchers Looking Closer At Physician Offices Hospital Industry Group Backs New Coding System Wye Group Report Identifies Citizens’ Health Policy Priorities Report: Electronic Disease Management Improves Diabetes Care RWJF Grant Will Study Technology’s Potential To Improve Disease Mgmt. Survey: Doctors Accelerating Acceptance Of Health Technology NACHC: Health Centers Help Reduce Racial Health Disparities Increased levels of health center penetration in low-income communities reduce racial and ethnic disparities, including lowering infant mortality and death rates, according to a report by the National Association of Community Health Centers, Inc. States with the highest penetration of health centers showed a 13.5 median difference in the percentage of Hispanic pregnant women without access to early prenatal care, compared to white women. However, in states with the lowest health center levels, the disparity was 17.5%, according to the study, Reducing Racial and Ethnic Health Disparities: Estimating the Impact of High Health Center Penetration in Low-Income Communities. The study was prepared by the George Washington University Medical Centers’ School of Public Health and Health Services. The report also said the disparity in black/white death rates was smallest in states with the higher penetration of health centers. States with at least 20% health center penetration were associated with a median of 166.5 per 100,000 additional black deaths, compared with 286 additional black deaths per 100,000 in states with the lowest health center penetration, according to the study. Dan Hawkins, vice president for policy at the association, said the report’s findings should demonstrate to Congress the vital role community health centers play in providing access to care. The Bush administration has pledged to increase the number of health centers to serve 10 million more patients, he said. For more info, www.nachc.com. Back to top Patient Safety Researchers Looking Closer At Physician Offices An increasing number of patient safety researchers are eyeing interventions that would improve safety in the primary care physician’s office, according to a report in the American Medical News. The report focused on a “first of its kind” recent conference in Chicago addressing patient safety in the primary care setting. The conference was sponsored by the Primary Care Organizations Consortium, the American Academy of Family Physicians and the Dept. of Family Medicine at the University of Chicago’s Pritzker School of Medicine. It addressed common primary care errors such as mixing test results of patients with the same name, diagnostic errors, laboratory test and x-ray foul-ups, administrative errors, knowledge and skill errors, and the different definitions of patient harm. The article said researchers were pleased that these issues led to the conference, because much of the research on these physician office medical errors have not yet been published. The AM News report said that John Hickner, MD, professor of family practice and associate chair for research at Michigan State University College of Human Medicine, East Lansing, served as principal investigator for the conference. He reported on a pilot study that highlighted the problems with many error-reporting systems. In particular, Dr. Hickner noted how few knowledge and skill errors were reported. For more info, www.aafp.org/prebuilt/ptsafety_finalagenda.pdf. Back to top Hospital Industry Group Backs New Coding System Following a field test, The American Hospital Association said the proposed ICD-10-CM medical code sets represent a significant improvement over the current ICD-9-CM coding system, and can be implemented without excessive staff training costs or changes in documentation practices. The proposed clinical codes represent a multiyear effort to create updated, more precise codes for quality assessment and other purposes such as reimbursement by payers including Medicare. They reflect medical advances of the last two decades. The ICD-10-CM codes are based on a system of classifying diseases and related health problems developed by the World Health Organization. The U.S. National Center for Health Statistics (NCHS) developed a clinical modification of the classification for morbidity purposes. NCHS, which advises Health and Human Services Secretary Tommy Thompson, conducted a public hearing Sept. 23-24 in Washington, D.C., and hopes to have a final vote on the ICD-10-CM standards by its Nov. 5-6 meeting. Without unforeseeable delay, final implementation of the codes could take place in late 2005 or early 2006. With more than 6,000 medical records coded using ICD-10-CM, most test-project participants, who included coding professionals from a variety of health care settings, acknowledged that ICD-10-CM represents an improvement over ICD-9-CM, and advocate migrating to the new system in three years or less, according to a report released jointly by AHA and the American Health Information Management Association. For more info, http://library.ahima.org. Back to top Wye Group Report Identifies Citizens’ Health Policy Priorities The Wye River Group on Healthcare has released a report on the results of a year-long project to determine views on health care policy in 10 communities. WRGH is an informal policy group including AARP, the American Hospital Association, Blue Cross/Blue Shield Association, Definity Health, the health policy journal Health Affairs, the Mayo Foundation, and the Pharmaceutical Research and Manufacturers of America. The report is based on roundtable discussions hosted by WRGH in 10 communities to gain insight on the values and principles that people believe should guide future health care policy. WRGH said many community leaders who participated in the project believe that most Americans view health care with a sense of entitlement and have unrealistic expectations of what the current health care system can deliver. The group chose to focus on a mix of communities, some with health care costs higher than the national average and some with lower costs. The mix of communities also included some that were rated high for health care quality and some with a lower quality rating. Also in the report are summaries of specific health care challenges, including access, quality, information infrastructure, incentives and the role of public health. WRGH said that its study is the first phase of a project that now will launch a campaign to raise awareness and engage the public in a dialogue on health care challenges, create channels for national health policy leaders to gain insight from communities, and demonstrate local solutions from 10 diverse model communities that have the potential to be replicated on a national level. For more info, www.wrgh.org/book_shaping.pdf. Back to top Report: Electronic Disease Management Improves Diabetes Care Patients with diabetes who participated in an electronic disease management program significantly improved their compliance with care guidelines, according to a new study published in the American Journal of Medical Quality. Researchers measured care management in two groups of diabetes patients at a free clinic in Venice, Calif. The 82 patients in the intervention group used an electronic disease management system that compiled clinical data on each patient and measured progress on eight management objectives, such as receiving certain tests and vaccinations. The 63 patients in the control group received no intervention and continued their normal care. The study found that the intervention patients significantly improved their compliance for seven of the eight objectives, while the control group only significantly improved in one area—receiving a pneumonia vaccine. The intervention group met an average of 56% of its target objectives six months before the electronic management program, compared with 82% six months after intervention. The control group met on average 48% of its targets before and 51% after six months, the report said. The authors recommended using the electronic systems in other settings as well. For more info, www.acmq.org. Back to top RWJF Grant Will Study Technology’s Potential To Improve Disease Mgmt. The Robert Wood Johnson Foundation has provided $4.8 million in grants for 18 recipients to study the use of technology to improve health behavior and disease management. The funds are part of the foundation’s Health e-Technologies Initiative, a national program dedicated to researching and developing health care IT. The awards range from one to three years and will address the challenges in evaluating health care IT applications or evaluating the outcomes of existing applications. Stanford University received two grants, including nearly $500,000 to evaluate an Internet-based self-management program for Type 2 diabetes patients, and another $50,000 to study the reliability of collecting self-reported health data via the Internet as compared to mail. For more info, www.hetinitiative.org. Survey: Doctors Accelerating Acceptance Of Health Technology A new survey said that physicians are embracing handheld devices and the Internet at a higher rate than consumers, according to a report in American Medical News. The survey, performed by Forrester Research Inc., found that 40% of physicians own a handheld device, compared with 8% of consumers. Doctors also are using high speed Internet access at nearly twice the rate of consumers in both their homes and offices. According to the AM News report, the survey could bode well for growing efforts to implement electronic medical records in provider settings. For more info, www.forrester.com. Back to top

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