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Hospitals
Unveil Public Reporting Web Site JAMA:
Medical Errors Result In Longer Stays, Bigger Expenses Article
Examines CA Physician Office Quality Incentives New
York City Health Dept. Releases Neighborhood Health Data Virginia
Company Rolls Out National Electronic Prescribing Network Georgia
PPO Sets Up Institute To Monitor Hospital, Doctor Quality Health
Officials Fear Mild Flu Seasons Breeding Complacency Survey:
Most Minorities Believe They Receive Worse Care Than Whites GAO:
Medicare Beneficiaries Don’t Access Full Preventive Services JCAHO
Seeks Applicants For Outcomes Measurement Award Hospitals
Unveil Public Reporting Web Site More than
1,700 hospitals have pledged to report quality data as part of the hospital-industry’s
public reporting initiative, but Centers for Medicare and Medicaid Services
(CMS) Administrator Thomas Scully said he was disappointed that data from
only 415 hospitals were posted in time for the initial public release
last week. The hospital
groups that unveiled the voluntary hospital reporting initiative in December
2002—including the American Hospital Association and the Federation
of American Hospitals— launched a hospital quality reporting Web
site with CMS last week that includes the initial data collected for participating
hospitals. The initiative
is intended to create a national database of hospital performance information
available to clinicians and consumers. The hospital quality initiative
consists of 10 quality measures for three conditions—heart attack,
heart failure, and pneumonia. Nancy Foster,
senior associate director for the AHA, said that fewer than half of the
acute care facilities eligible to participate in the hospital quality
initiative have signed up; of those, only 415 have data in one of the
10 measures available on the Web site. Hospital
officials said 685 hospitals reported data for at least one of the quality
measures by a July deadline for reporting, but 270 hospitals experienced
a variety of technical problems, primarily concerning transmitting data
into the database. Hospitals have until Nov. 15 to submit data in time
for the next reporting deadline in February 2004. Hospital
officials added that they are looking to expand the current set of measures,
and perhaps will include conditions identified by the Institute of Medicine’s
Priority Areas for Quality Improvement report. Association
of American Medical Colleges Health Care Quality Liaison and Director
Jennifer Faerberg said that improving participation among hospitals is
a primary goal of the hospital organizations involved with the initiative.
Faerberg pointed out the 1,700 hospitals that pledged to voluntarily report
represent 43% of the beds in the country and 46% of all admissions. Also, the
AMA released a statement from its Immediate Past-President Dr. Yank Coble,
that said the organization “looks forward to working with the partner
organizations to develop additional hospital reporting measures and believes
that processes of care measures are as critical as clinical measures in
measuring hospital quality.” JAMA:
Medical Errors Result In Longer Stays, Bigger Expenses Injuries
caused by medical errors in hospitals often result in increased lengths
of stay and larger medical expenses, according to an article in the Oct.
8 issue of the Journal of the American Medical Association. Researchers
from the Agency for Healthcare Research and Quality and Johns Hopkins
University, Baltimore, examined the excess length of stay, costs, and
deaths attributable to medical injuries during hospitalization. The researchers
said postoperative bloodstream infections had the most serious consequences,
resulting in hospital stays of almost 11 days longer than normal, added
costs of $57,727, and an increased risk of death after surgery of 21.9%.
Researchers estimated that 3,000 Americans die each year from postoperative
bloodstream infections. The next
most serious event was postoperative reopening of a surgical incision,
with 9.4 excess days, $40,323 in added costs, and a 9.6% increase in the
risk of death, which could equate to an about 405 deaths from reopening
of surgical incisions annually. “This
study gives us the first direct evidence that medical injuries pose a
real threat to the American public and increase the costs of health care,”
AHRQ Director Carolyn M. Clancy, M.D, said in a statement. “The
nation’s hospitals can use this information to enhance the efforts
they already are taking to reduce medical errors and improve patient safety.”
The AHRQ
researchers said the study suggests more research is needed to understand
circumstances and risk factors associated with medical injuries.
For more
info, www.jama.ama-assn.org. Article
Examines CA Physician Office Quality Incentives Physician
organizations in California are more likely than their counterparts outside
the state to be paid for improving health care quality, and are more likely
to follow case management or similar practices for treating chronically
ill patients, according to a new Health Affairs article published
this week. The wider
application of care management processes by California’s medical
groups and independent practice associations may be linked to the more
frequent use of financial performance tools, other external incentives
for improving quality, and increasing investment in clinical information
technology, said the article, which was supported by the California HealthCare
Foundation. Robin R.
Gillies, a project director in the Department of Health Policy and Management
in the University of California, Berkeley, School of Public Health, and
four colleagues analyzed data from a national survey of leaders of more
than 1,100 physician organizations with more than 20 physicians, 20% of
the organizations studied were in California. To improve
quality, California medical groups are more likely to employ special hospitalist
physicians to coordinate care of their hospital patients; more likely
to use case management for chronically ill patients more often; and use
preventive tools to reduce hospitalization among patients with diabetes,
asthma, and congestive heart failure. The study
also said California physician organizations had greater incentives to
use quality improvement tools. Insurers were more likely to pay California
medical groups on the basis of quality, as well as publicly report outcomes
data and the results of continuous quality improvement initiatives. In
California, 53.3% of medical groups received income for quality, compared
to 39.8% of non-California medical groups, the study said. For more
info, www.healthaffairs.org/WebExclusives/Gillies_Web_Excl_101503.htm. New
York City Health Dept. Releases Neighborhood Health Data The New York
City Department of Health and Mental Hygiene (DOHMH) for the first time
unveiled 42 comprehensive Community Health Profiles that provide detailed
information on the health of New York City’s neighborhoods. Neighborhood-by-neighborhood,
the reports detail the leading causes of death and hospitalization, how
New Yorkers view their health, and how New Yorkers balance healthy and
unhealthy behaviors. The reports will be used to guide health professionals,
public officials, community leaders and residents on which health problems
require the most attention, and where interventions are needed most, city
officials said. “While
many health burdens are shared across the city, some communities are faring
better than others. These reports make it clear where the greatest efforts
must take place to address and reverse health problems, particularly those
that are preventable,” said Health Commissioner Dr. Thomas Frieden.
The reports provide detailed information, charts and graphs that include: Some
of the major findings include: These reports
are being distributed to health providers, community organizations, elected
officials, libraries, the media and a host of other community stakeholders,
city officials said. For more info, www.ci.nyc.ny.us/html/doh. Virginia
Company Rolls Out National Electronic Prescribing Network Alexandria,
Virginia-based SureScript Systems has announced the start of what it calls
the largest national network focused on improving the overall prescribing
process. Saying that
more than 50% of the country’s 55,000 pharmacies will be connected
to its SureScripts Messenger Services before the end of 2003, the company
said it will soon roll out the system starting with Maryland and Virginia
this month, followed by California, Illinois, Ohio, and perhaps Massachusetts
by the end of the year. The company said the system will allow pharmacies
in those states to transmit prescription information to and communicate
with physician practices in a two-way, electronic format that eliminates
fax, phone, pen and paper from the prescribing process. Albertsons,
Brooks, CVS, Eckerd, Giant, Kroger, Longs, Rite Aid, Sav-On, Stop and
Shop, Osco, Walgreens and Wal-Mart, as well as many of the nation’s
independent community pharmacies, are among those connecting to the network,
SureScripts said. The company added that broad participation of the retail
pharmacy industry will result in increased use of an electronic system,
which is expected to address issues and concerns that beleaguer the current
prescribing process including safety, accuracy, efficiency, convenience
and the quality of information at the point of care. SureScripts
said it is working with community pharmacies, technology vendors, health
care quality improvement groups, and physician associations to raise awareness
in communities and among physicians’ offices about the benefits
of true electronic prescribing. However,
according to an American Medical News report, many are skeptical
that doctors will flock to the system. The report said many doctors won’t
use e-prescribing systems without a government mandate because of the
expense involved and because they believe the technology is unreliable. SureScript
officials argue that the electronic system will help increase profits
for physician practices. The company estimates that 450 million of the
3.4 billion prescriptions dispensed each year require physician authorization
that result in more than 900 million phone calls and faxes, costing more
than $2 billion per year. For more
info, www.surescripts.com. Georgia
PPO Sets Up Institute To Monitor Hospital, Doctor Quality One of Georgia’s
largest PPO health plans has set up a nonprofit institute to monitor quality
in 140 community hospitals statewide and keep tabs on the care delivered
by 17,000 Georgia physicians, the Atlanta Business Journal reported.
Formed last
year when Georgia 1st and Medical Resource Network (MRN) merged their
PPO networks, 1st Medical Network now has 650,000 members, most of them
state employees. 1st Medical Network has compiled two years’ worth
of data on 1.7 million insurance claims and is now mining that data, searching
for trends or areas where medical-care delivery can be improved, Network
CEO Ken Tannenbaum told the publication. Through the
Georgia Institute for Quality Healthcare, 1st Medical Network plans to
develop new quality programs based on the analysis of claims data. The
institute will also partner with insurance carriers, employers and the
medical community to help raise quality standards. 1st Medical
Network officials indicated that eventually, some of the information might
be available to consumers to help them select providers, the report said.
For more
info, www.1stmn.com. Health
Officials Fear Mild Flu Seasons Breeding Complacency Federal and
local health officials are urging people to get their influenza vaccinations
and not become complacent about the potentially serious complications
of the flu The Centers
for Disease Control and Prevention is among the groups that have increased
their efforts to persuade as many people as possible to get vaccinated
this fall. “We’ve
had three relatively mild flu seasons, and I think people have short memories
and may forget how ill they can get from influenza,” Dr. Carolyn
Bridges, a medical epidemiologist and flu specialist at the Centers for
Disease Control and Prevention, told the New York Times. Flu vaccination
rates, even among groups most at risk for serious influenza episodes,
routinely fall well below 50%, CDC said. According to the CDC, influenza
and complications arising from it, like pneumonia and heart failure, kill
an average of 36,000 people a year in the United States, a vast majority
of them elderly. The illness also leads to an estimated 114,000 hospitalizations
annually. The agency
recommends vaccination most strongly for demographic groups with the highest
risk for developing serious illness, among them people at least 6 months
old who suffer from asthma, diabetes, heart disease and some other chronic
disorders; women more than three months pregnant; and everyone 50 and
older. Several factors
should help make vaccines more accessible to a broader population than
in the past, CDC said. Although supply shortages hampered vaccination
campaigns in 2000 and 2001, the agency said those problems have been solved.
For more
info, www.cdc.gov/nip/flu/News.htm. Survey:
Most Minorities Believe They Receive Worse Care Than Whites A new poll
reveals that while Americans are divided about the extent to which racial
and ethnic health care disparities exist, African Americans and Hispanics
are as much as three times more likely than whites to feel that minorities
receive a lower level of care. The survey
said that although one in five whites acknowledge that minorities receive
lower levels of quality medical care than whites do, two-thirds of African
Americans feel that way and 41% of Hispanics do as well. The survey results
were released at a Nashville, TN-forum co-sponsored by the Harvard Forums
on Health, the journal Health Affairs, and others. The survey
cited several reasons for unequal treatment, including cultural and language
barriers and discrimination on the part of health professionals. It also
revealed that large numbers of Americans support penalizing providers
and insurers with a history of delivering unequal care based on a person’s
race or ethnicity. “The
poll findings show a persistent feeling among minorities that the care
they are getting is not equal to that of whites,” said David Blumenthal,
MD, director of Harvard University’s Interfaculty Program on Health
Systems Improvement, which organized the forum. “Inequality in medical
access and treatment is a problem for many Americans that can no longer
be ignored,” he said. Harvard officials
said many of the responses validated a 2002 Institute of Medicine report
that said racial and ethnic minorities receive lower quality health care
than whites even when they are insured and other factors are considered.
For more
info, www.phsi.harvard.edu GAO:
Medicare Beneficiaries Don’t Access Full Preventive Services While most
Medicare beneficiaries receive some of the preventive services provided
by the federal program, relatively few receive the full range of services
available, according to a new General Accounting Office report. Medicare
provides preventive services, such as flu shots and mammograms, but GAO
said that in 2000, about 30% of beneficiaries did not receive a flu shot,
and 37% were not vaccinated against pneumonia. While Medicare
was created to pay for beneficiaries’ health care when they become
ill or injured, GAO noted that Congress has broadened coverage to include
preventive services that, like flu shots, keep an illness from developing,
or, like mammograms, keep it from becoming more serious. Rep. James
Greenwood (R-PA) asked GAO to examine the preventive services that beneficiaries
receive at physician visits; to explore whether approaches used by Medicare+Choice
plans provide insight for providing preventive services to Medicare fee-for-service
participants; and to examine what the Centers for Medicare and Medicaid
Services is doing to improve delivery options. Greenwood is chairman of
the House Energy and Commerce Subcommittee on Oversight and Investigations.
GAO found
that beneficiaries often are unaware that they have a condition that preventive
services are intended to detect. In one 1999-2000 study used for the report,
nearly one-third of those age 65 and older—about 2.1 million people—who
were found to have high cholesterol said they had not been told by their
doctor about the condition. GAO examined
five Medicare+Choice plans that are considered to have innovative approaches
to preventive services. But the agency reported that no best practice
approach stood out among M+C plans GAO studied. GAO said
that all five plans it studied identified health risks, provided feedback
on risks to patients, and followed up to reduce those risks, “but
their follow-up programs, approaches, and priorities differ, and little
is known about the effectiveness of these efforts for the Medicare-age
population.” The five health plans included: AvMed Health Plans
(Florida), Group Health Cooperative (Washington), Highmark Blue Cross
and Blue Shield (Pennsylvania), Kaiser Permanente (District of Columbia,
California, and eight other states), and Oxford Health Plans (Connecticut,
New Jersey, and New York). For more
info, www.gao.gov. JCAHO
Seeks Applicants For Outcomes Measurement Award The Joint
Commission on Accreditation of Healthcare Organizations (JCAHO) is accepting
applications for the eighth annual Ernest A. Codman Award. This award
recognizes excellence in the use of outcomes measurement by organizations
and individuals to achieve improvements in the quality and safety of health
care. Applications are due April 5, 2004. JCAHO said
application forms are being made available earlier to provide more time
for organizations to complete and submit the required information and
materials. The revised application has been modified to enhance the clarity
of the Codman Award requirements and streamline the supporting documentation
requirements. Named for
the physician regarded in health care as the “father of outcomes
measurement,” the Ernest A. Codman Award showcases the effective
use of performance measurement by health care organizations and individuals
to improve the quality and safety of health care. An award may be given
in each of the following categories: ambulatory care, behavioral health
care, hospital, home care, laboratory, long term care, network, multiple
organization, and individual. Health care
organizations may submit any performance measurement and improvement initiative
that reflects the accomplishment of a significant performance improvement.
Applicant-organizations must demonstrate an organization-wide commitment
and approach to data driven improvement, JCAHO said. This year’s
Codman Awards will be presented December 3 at the Joint Commission’s
2003 National Conference on Quality and Safety in Health Care at the Chicago
Hilton and Towers. For more
info, www.jcaho.org.  Home :: Inside AHQA :: For The Media :: Public Policy :: Advancing Quality :: Quality Connections :: SiteMap
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