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Study:
Shorter Hospital Stays Don’t Result In Poorer Quality Disease
Management May Not Pay Off Firm
Readies Web-Based Patient Safety Reporting System Foundation
Rallies Support For National Disease Database Aetna
To Start High-Quality Physician Network In January 2004 Foundation
To Award Grants Supporting Health Care IT Efforts
California
HealthCare Foundation Releases Three Reports on EMRs Alliance
To Examine Implementation Issues For Countrywide EHR Study:
Californians With Limited-English Report Poorest Health Study:
Shorter Hospital Stays Don’t Result In Poorer Quality The Veterans
Affairs health care system has slashed the time veterans spend in the
hospital by half without sacrificing quality of patient care, according
to a new study published in the Oct. 23 New England Journal of Medicine. Starting
in 1995, the VA began an effort to significantly reduce unnecessary hospital
stays and encourage veterans to get routine care for chronic conditions,
according to the study’s author and former VA health care system
head Ken Kizer. The new report
indicates that the effort paid off. The study examined the records of
342,300 seriously ill veterans who got their care at the VA from 1994-1998.
It found overall hospital use dropped 50% during that time, and that care
delivered in outpatient settings increased by about 10%. The study also
found that urgent-care visits dropped by 37%. Researchers
said that the study shows that more care isn’t necessarily better
care, noting that these patients were picked because they were the sickest
and most vulnerable veterans and would best indicate the VA reforms impact
on quality. The study
found that survival rates held steady for the group as a whole, and for
some conditions, such as heart failure, survival rates improved. For more
info, www.nejm.org. Disease
Management May Not Pay Off More employers
and health plans are giving extra attention to patients with chronic conditions
and costly, complex illnesses, but there is limited evidence to support
the cost-effectiveness of these disease management programs, according
to a new study by the Center for Studying Health System Change (HSC). More employers
are turning to disease management programs in hopes of slowing double-digit
health insurance premium increases, HSC said. Disease management programs
typically focus on patients with chronic conditions, such as asthma or
diabetes, where practitioners’ adherence to evidence-based treatment
guidelines and patient self-care and compliance are critical. Employers
also are experimenting with intensive case management programs focusing
on care coordination for high-risk patients with multiple or complex medical
conditions. “In
theory, if patients get the right care at the right time in the right
place, it should help control costs and improve quality. In practice,
however, evidence of disease management reducing costs and improving care
is quite limited,” said Paul B. Ginsburg, Ph.D., president of HSC,
a nonpartisan policy research organization funded by The Robert Wood Johnson
Foundation. The study
examined disease management trends based on site visits to 12 nationally
representative communities in 2002-03. For more
info, www.hschange.com. Firm
Readies Web-Based Patient Safety Reporting System ECRI, a Pennsylvania
health services research company, will soon unveil a new Web-based system
for reporting medical errors to the state as required by the state’s
patient safety law. Designed
to improve patient safety, the system will be first tested at 20 hospitals
from different parts of Pennsylvania this fall, according to ECRI, which
is considered by some to be the Consumer Reports of the medical-device
industry. ECRI was awarded a $9.2 million, five-year contract by Pennsylvania’s
Patient Safety Authority in July to design, develop and implement the
medical error reporting system. The Patient
Safety Authority was created as an independent state agency to help control
escalating malpractice insurance premiums in Pennsylvania. State law requires
the state’s 355 licensed hospitals, birthing centers, and ambulatory
surgical facilities to report two types of events to the authority: “serious
events,” which consist of situations that compromise patient safety
or resulted in patient injuries or death, and “near misses,”
referred to as incidents where a patient could have been injured, but
wasn't. Funding for
the database is coming from a $10 million assessment on hospitals collected
during the past two years. Hospitals failing to report incidents to the
authority can be fined up to $1,000 per day. ECRI will
analyze the data collected from hospitals and other facilities to look
for trends in medical errors, and the Patient Safety Authority will then
work toward developing strategies to address real or potential problems.
Hospitals will be able to review ECRI's analysis of their own data, but
not data from other hospitals. Each hospital will also be able to compare
its data to a statewide aggregate. ECRI is developing
the reporting system in a partnership with the Institute for Safe Medication
Practices and EDS. For more
info, www.ecri.org. Foundation
Rallies Support For National Disease Database Bolstered
by a partnership with the Agency for Healthcare Research and Quality,
philanthropist Joe Kanter is attracting influential leaders in support
of a database to allow patients and doctors to better treat diseases. Kanter, a
retired developer and cancer survivor, wants a system where a patient
diagnosed with a chronic condition or disease can learn about what treatments
work or didn’t work on similar patients. At a Washington, DC press
conference last week, Kanter said the national database would lower costs
and improve care. AHRQ and
the Kanter Foundation brought together former Senate leaders Bob Dole
and George Mitchell, as well as Senate Majority Leader Dr. Bill Frist
(R-TN) in support of the National Health Outcomes Database. According
to an article in the Miami Herald, a recent study estimated that
the database could cost between $5 million-$10 million per year to standardize
records and keep them updated. However, there is a question as to who
will own the data, and whether they would allow the medical data to be
made public, the article said. For more
info, www.healthlegacy.org. Aetna
To Start High-Quality Physician Network In January 2004 Aetna is
planning a three-city program featuring networks of doctors that have
achieved better health outcomes, according to an article in the Florida
Times Union. The article
said Aetna is establishing networks of doctors based on physicians’
volumes of work, quality outcomes and effectiveness. The group of physicians
is about half the size of the previously existing network. The team includes
specialists in cardiology, cardiothoracic surgery, gastroenterology, general
surgery, orthopedics and obstetrics/gynecology, which are some of the
highest cost-drivers for the company. The company
is not paying doctors more as part of this network but may increase business
through other steps, the article said. For instance, patients won’t
have to get referrals to see these select specialists. And as part of
a smaller network of doctors, some physicians may experience a higher
volume of patients, and as a result more income. The Times-Union
article said Aetna created its program in response to client requests
and said it expects other insurers to start taking similar steps soon.
For more
info, www.aetna.org. Foundation
To Award Grants Supporting Health Care IT Efforts The Foundation
for eHealth Initiative has announced a $3.9 million grant program for
communities working to improve health care through the use of information
technology. The Connecting
Communities for Better Health Program will create a learning community
network to educate health care practitioners on various e-solutions for
health care. Focus areas will include sustainable business models, privacy
and security issues, technical architecture, and other technological applications.
The deadline
for grant applications is Nov. 19. The Foundation
for eHealth is a council of health care leaders committed to improving
the quality, safety and efficiency of health care through information
and information technology. The grant is being launched in cooperation
with the HHS Health Resources and Services Administration. For more
info, www.connectingcommunitiesprogram.org/news.aspx. California
HealthCare Foundation Releases Three Reports on EMRs The California
HealthCare Foundation (CHCF) has released three publications on electronic
medical records (EMRs) including a report on how small physician groups
are using EMRs; a buyer’s guide on leading EMR applications; and
an overview of the use and adoption of computer-based patient records
(CPRs). According
to CHCF, thousands of medical errors occur each year because of incomplete
access to a patient’s medical record. The use of EMRs has the potential
not only to reduce the number of medical errors but also to improve the
quality and efficiency of care, CHCF said. CHCF said
it commissioned the reports to better understand how physicians currently
use EMRs, what products currently exist, and what factors may hinder or
promote the adoption of EMRs. The new reports
include: For more
info, www.chcf.org. Alliance
To Examine Implementation Issues For Countrywide EHR The National
Alliance for Healthcare Information Technology announced that it will
look closely at implementation issues as it takes part in collaborative
efforts toward creation of a standard for a national electronic health
record (EHR). The Alliance—a
partnership of hospitals, associations, vendors, purchasers and related
groups—said it has spent considerable time drawing together private
sector input that the standards organization Health Level 7 is using in
its HHS-designated role in designing an EHR standard. The Alliance
said that its continuing work will focus on implementation issues such
as costs, integration with legacy systems among participants, compliance
with existing regulations, and how (or whether) to phase in EHR's launch.
For more
info, www.nahit.org. Study:
Californians With Limited-English Report Poorest Health Health difficulties
plague California Latinos and seniors with limited-English proficiency,
according to a new report by the UCLA Center for Health Policy Research.
About 44.7%
of the state’s older Latinos and 46.2% of seniors with limited-English
abilities report poor or fair health. In contrast, just 30% of California’s
total population of 3.6 million residents age 65 and older report poor
or fair health, and 26% nationwide. Using data
culled from California Health Interview Survey (CHIS) 2001, the 137-page
report provides detailed profiles of health behavior, health status and
preventive care among California’s oldest residents. Data are available
by region, county, gender, ethnicity, income level and English proficiency.
The report
examines specific health behaviors such as smoking and drinking habits;
health status in relation to heart disease, diabetes, asthma, hypertension,
arthritis, skin cancer, difficulty in climbing stairs and emotional problems;
preventive care such as cancer screening, bone density testing, hormone
replacement therapy and influenza immunization; and use of medical, dental
and prescription medication services. For more
info, www.calendow.org.  Home :: Inside AHQA :: For The Media :: Public Policy :: Advancing Quality :: Quality Connections :: SiteMap
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