Quality Update for December 12, 2003

Survival Rate of Major Surgeries Linked to Surgeon Volume High-Alert Medications Continue to Harm Patients in 2002 Hospital Market Share Unaffected by Published Mortality Rates Group Visits May Result in Better Diabetes Care Quality Measures Tutorial Now Available on CD-ROM HHS Unveils Grants Website CMS Publishes Revised HCAHPS Premier Backs Quality Initiative Patient Safety Abstracts Due Dec. 16 Computers More Likely To Be Used for Admin, Not Clinical, Work (NOTE: The next issue of Quality Update will be published on January 10, 2004.) Survival Rate of Major Surgeries Linked to Surgeon Volume Seeking out surgeons who frequently perform certain cardiac or cancer-related operations may increase older patients’ odds of surviving major surgery, according to a new study published in the Nov. 27 issue of the New England Journal of Medicine. The study, “Surgeon Volume and Operative Mortality in the United States,” was led by researchers at Dartmouth Medical School. It found that patients of high-volume surgeons had lower death rates for heart bypass surgery, carotid endarterectomy—an operation to prevent stroke—lung resection, and five other cardiovascular and cancer procedures than did patients whose surgeons performed these operations less frequently. The likelihood of operative death for low-volume surgeon’s patients was 24% greater for lung resection—an operation in which part or all of a lung is removed—and nearly four times greater for pancreatic resection surgery as compared with patients of high-volume surgeons. Surgeon volume accounted for much of the apparent effect of hospital volume, ranging from 100% for aortic valve replacement to 24% for lung cancer surgery. The study findings suggest that high-volume surgeons’ patients had lower death rates even when operated on in low-volume hospitals, while the patients of low-volume surgeons had higher death rates regardless of where they had their surgery. For more info, visit www.nejm.org. High-Alert Medications Continue to Harm Patients in 2002 MEDMARX, a national, Internet-accessible anonymous reporting database developed by United States Pharmacopeia to track and trend medication errors, found that high-alert medications continued to harm hospitalized patients in 2002. As in the 2001 MEDMARX data, eight of the 10 products most often involved in medication errors that caused patient harm were high-alert medications. In both years, the eight high-alert products in the list of top 10 products harming patients represented 35.1% of all medication errors that caused harm to the patient. Examples of recurring high-alert medication include insulin, morphine, heparin, potassium chloride, warfarin and hydromorphone. USP called for all high-alert medications to be packaged, stored, distributed, prescribed, dispensed and administered safely to minimize the risk of injury to patients. For more info, www.usp.org. Back to top Hospital Market Share Unaffected by Published Mortality Rates An initiative to publish mortality rates of Ohio hospitals did not reduce the market shares for hospitals whose rates were worse than expected. The Cleveland Health Quality Choice program showed several hospitals with significantly higher than expected mortality rates, longer hospital stays and lower patient satisfaction. However, no hospitals lost contracts by making the information public. The initiative did not address patient loss. For more info, see the June 2003 issue of Medical Care, pp. 729-740 in a study by Dr. Baker, et al. Back to top Group Visits May Result in Better Diabetes Care A pilot study by the Agency for Health care Research and Quality indicates that group visits improve the care of uninsured and inadequately insured diabetes patients. The study reported that group visits allow more time to address specifically diabetes-related issues and the monthly visits give patients more opportunities to ask questions. Managed care organizations have begun using the group visit approach, and the study shows that it may be one way to improve the efficiency of care while controlling costs. For more info, Diabetes Care 26 (7), pp. 2032-2036, by Dawn E. Clancy, MD, et al. Back to top Quality Measures Tutorial Now Available on CD-ROM A CD-ROM on using the National Quality Measures Clearinghouse (NQMC) is now available free of charge. The clearinghouse, created by the Agency for Health care Research and Quality, is a Web-based public resource of evidence-based health care quality measures and measure sets that are used to inform health care decisions. The tutorial includes a series of demonstrations and scenarios on using the NQMC. The CD-ROM is available free of charge by calling the AHRQ Publications Clearinghouse at 1-800-358-9295 or by sending an e-mail to ahrqpubs@ahrq.gov. For more info, info@qualitymeasures.ahrq.gov. Back to top HHS Unveils Grants Website The Department of Health and Human Services announced a new website to allow individuals and organizations to find and apply online for competitive grant opportunities from all federal grant-making agencies. The site, www.grants.gov, is designed as a storefront for anyone seeking to find, apply or manage a federal grant. While led by HHS, grants.gov covers more than 900 grant programs offered by the 26 federal grant-making agencies. HHS said it hopes the site will streamline the process of awarding over $350 billion annually to state and local governments, academia, not-for-profits, and other organizations. According to the federal government, HHS awards more than half of all federal competitive grants. Back to top CMS Publishes Revised HCAHPS Last week, the Centers for Medicare & Medicaid Services published a revised version of the Hospital Consumer Assessment of Health Plans Survey, a survey instrument for collecting and evaluating patient perceptions of care. The survey, which will become part of the hospital-led Quality Initiative, is designed to allow for an accurate comparison of patient satisfaction across hospitals. The survey consists of 32 questions, mostly addressing the patients’ perceptions of the hospital environment and care they received. Eight will determine demographics and patient-mix. Hospitals will be permitted to incorporate the survey into their current patient satisfaction survey (by adding up to 30 questions following the 24 core HCAHPS questions) and to use their current survey vendor to administer the survey. CMS intends for surveys to be administered in most hospitals to about 80 adult patients per month, 48 hours to 12 weeks after discharge. The agency said it would determine a lower number for smaller hospitals. The agency has not yet determined when results will be reported on its website as part of the Quality Initiative, and is considering a trial period in which results are not publicly shared. Back to top Premier Backs Quality Initiative Premier Inc., a group purchasing organization affiliated with about 1,500 hospital facilities, is encouraging hospitals to participate in the hospital-led Quality Initiative. Premier officials said the effort is compatible with its Medicare demonstration project with the Centers for Medicare & Medicaid Services, which gives hospitals financial incentives for quality improvement in five clinical areas, three of which are the same as conditions used in the Quality Initiative. The project is managed by the Premier hospital alliance and the Centers for Medicare and Medicaid Services (CMS). Eligible hospitals subscribe to the national clinical database, which is operated by Premier. Nearly 60 organizations, including the U.S. Chamber of Commerce, have endorsed the Quality Initiative, and 2,211 hospitals have volunteered to participate since it was opened to hospital enrollment in May. For more info, www.aha.org and click on the “Quality Initiative” logo. Back to top Patient Safety Abstracts Due Dec. 16 The Agency for Health care Research and Quality and the Department of Defense are partnering to produce a set of reviewed papers in book form on patient safety that is scheduled for release in the fall of 2004. The publication, Advances in Patient Safety: From Research to Implementation, will highlight the research findings, methodological perspectives, implementation issues, and tools and products stemming from recent federally funded patient safety research. Abstracts and papers for inclusion can be submitted in one of the following four categories: conceptual frameworks and research, methodological perspectives, implementation issues, and tools and products. The deadline for abstract submission is Dec. 16 and the deadline for manuscripts is April 26, 2004. For more info, www.ahrq.gov/news/calladvs.htm. Back to top Computers More Likely To Be Used for Admin, Not Clinical, Work A new study found doctors are more likely to use computers for administrative functions rather than clinical applications, largely due to time and start-up costs connected with implementing new technologies. The Massachusetts Medical Society and the University of Hong Kong Department of Community Medicine surveyed 423 Massachusetts physicians and found that 71% have implemented computerized systems for patient scheduling, billing and payment, as well as registration and patient details. Another 69% of respondents have computerized claims systems, 67% have financial management systems and 62% have computerized payroll systems. On the clinical side, however 85% of respondents said doctors should be writing electronic prescriptions, but 49% do not plan to adopt the technology. Eighty-nine percent said doctors should computerize patient summaries, but 49% said they have no intentions to do so. For more info, www.massmed.org. Computer Drug Rx System Cuts Medication Errors 80% A Boston hospital has reduced its medication errors by more than 80% by moving to a computerized drug ordering entry system. In a Nov. 23 article, The Boston Globe reported that Brigham and Women’s Hospital developed a system five years ago that uses electronic medical charts and color codes to indicate allergies and time lapses between medications. When an error occurs at Brigham or another hospital, the hospital’s physicians and computer programmers often use the failure to add another safety level to the electronic ordering system. About 5% of U.S. hospitals have installed electronic drug-ordering systems. Partners Health care, Brigham’s parent organization, plans to spend more than $30 million in five years to expand Computer Physician Order Entry to all its hospitals and electronic medical records to all its doctors. For more info, www.boston.com. Back to top

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