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HHS
Releases National Health Care Reports Quality
Forum to Standardize Performance Measures Task
Force Encourages Shared Decision Making Many
Breast Cancer Patients Not Receiving Recommended Chemotherapy, Study Finds Public
Meetings to Address EHRs Texas
Health Care System to Install Electronic Patient Records Aetna
Software Catches Rx Errors Kaiser
Conducts Public Survey on Knowledge of Medicare Bill VHA
Software May Be Used to Help Developing Countries eHealth
Initiative: 42 States, 130 Groups Express Interest in EHI HHS
Releases National Health Care Reports HHS issued
its long-awaited National Healthcare Quality Report and National Healthcare
Disparities Report on Dec. 22, 2003. The two reports, which provide baseline
views of quality and health care disparities that will be updated annually,
are available at www.qualitytools.ahrq.gov.
They were largely produced by the Agency for Healthcare Research and Quality
(AHRQ) at HHS. The quality
report presents data and evaluates quality of care for cancer, diabetes,
ESRD, heart disease, AIDS, maternal and child health, mental health, respiratory
disease, and nursing home and home health care. The disparities report
looks at quality and access to care for women, children, seniors, racial
and ethnic minorities, low-income groups and rural residents. AHRQ Director
Carolyn Clancy told reporters at a press conference that the reports are
the result of a groundbreaking effort to pull data together from a variety
of sources. “Up to this point, the data from these sources have
been published as ‘snapshots’ of the American health care
system,” Clancy said, noting that the reports “represent the
first national, comprehensive effort to measure and report the quality
of health care in America, as well as differences in access to health
care services for priority populations.” The 1st Annual
Institute of Medicine Crossing the Quality Chasm Summit, sponsored
by the Robert Wood Johnson Foundation, brought together 175 individuals
from 15 local communities and national health care leadership groups in
Washington this week. Participants focused on efforts to advance local
and national quality improvement efforts in five priority areas—asthma,
chronic heart failure, depression, diabetes, and pain control in cancer.
The summit
represented an initial effort to implement health system changes recommended
in the IOM’s landmark Crossing the Quality Chasm report.
The immediate objective of the summit was to describe measurable goals
and appropriate strategies for improving care in the five targeted areas,
selected from 20 priority conditions identified by a previous IOM panel;
to identify performance measures to assess progress over the next 3-5
years; and to support relationships and collaboration among local and
national efforts. Institute
for Healthcare Improvement CEO Dr. Donald Berwick served as keynote speaker
for the conference, urging participants to continue their work towards
a more effective, more efficient health care system. Berwick compared
the challenge to improve health care quality with trying to squeeze additional
speed out of vehicle not designed for high performance. Calling for a
health care system that more resembled a Jaguar than a Ford Windstar,
he noted that the current health care system is “perfectly”
designed to produce the results it gets. “‘American
health care is poor, not good. American health care is poor, not good,”
Berwick said. In addition
to addressing a number of crosscutting topics—such as information
technology, care coordination, finance, measurement and patient self management—groups
for each clinical topic area developed action plans that the IOM plans
to compile within three months into a report summarizing the conference.
The diabetes
group, for instance, determined that quality would improve by paying providers
more for better performance, providing payments for group visits and effective
care coordination, and finding incentives for patients to better manage
their disease. The group also said that patient-accessible standardized
electronic health records and networks allowing health professionals to
share information about best practices—beyond peer-reviewed journals—would
also result in better quality of care for diabetes patients. At the end
of the summit, numerous national leaders including officials from the
Centers for Medicare and Medicaid Services, Agency for Healthcare Research
and Quality, National Institutes of Health, medical professional societies,
accrediting organizations, health care purchasing organizations, and other
groups announced their commitment to supporting local successes. For more
info, www.iom.edu/project.asp?id=9868. Quality
Forum to Standardize Performance Measures The National
Quality Forum plans to launch an initiative that would standardize performance
measures for outpatient care, including doctor’s offices and hospital-based
outpatient facilities. The four-year
initiative will identify voluntary consensus standards for measuring the
quality of outpatient care. One goal is to streamline the workload of
a physician who may belong to several health plans, each with different
performance measures. The first
phase of the project includes a literature review and assessment of available
and needed measures as well as a report on the findings. Future phases
would address specific measures to be implemented and when. For more
info, www.qualityforum.org.
Task
Force Encourages Shared Decision Making Patients
should take an active role with clinicians about which preventive care
services are most appropriate, according to a paper published last month
by the U.S. Preventive Services Task Force. The paper,
published in the American Journal of Preventive Medicine, defines shared
decision making as a collaborative effort between the patient and clinician
in exploring acceptable medical options and choosing a preferred course
of clinical care. Task force members cited several examples of where shared
decision making maybe useful, such as aspirin therapy, which helps patients
prevent heart disease but may cause stomach bleeding in some patients
and colorectal cancer screening, where five screening options are available.
To encourage
patient participation, the paper suggests helping patients understand
the value of their role in determining the path of medical care. To encourage
clinicians, task force members suggested developing a systemic approach
that is likely to improve the quality of patient interaction. For more
info, www.ahrq.gov/clinic/3rduspstf/shared/sharedba.htm.
Many
Breast Cancer Patients Not Receiving Recommended Chemotherapy, Study Finds
More than
half of the women who underwent breast cancer treatment did not receive
the recommended schedule of chemotherapy, which may have put them at risk
for recurrence of the disease, suggests a study published in the Journal
of Clinical Oncology. In the study,
researchers looked at medical records of about 20,000 women who were treated
by more than 1,200 doctors across the country. Their analysis found that
doctors delayed therapy or cut back dose intensity because of the concern
of side effects. More than half the patients received fewer than 85% of
the recommended dose intensity. Previous
studies have linked such reduction with an increase in the risk of relapse
and death. However, whether or not the women suffered as a result of the
reduced treatment was not a part of the study. “The
implication is that perhaps we can do better as a community to give as
close to the planned dose intensity as possible,” Dr. George Raptis,
head of the clinical breast cancer program at Mount Sinai School of Medicine,
told The New York Times. Public
Meetings to Address EHRs The EHR Collaborative—a
group of organizations representing key stakeholders in health care—is
conducting a series of meetings in January and February to gather feedback
on the latest draft model for an electronic health record (EHR). Developed
by the EHR special interest group (SIG) of Health Level Seven (HL7), the
model is intended to serve as a national standard for EHR systems to improve
quality of care and patient safety. A series
of four conference calls will follow during which input and feedback on
the model will be gathered. Conference calls will be held at 2 p.m. EST
for the following care settings: Jan. 8:
Community Care Those interested
in participating can register by sending an e-mail to: info@ahima.org
with the words “EHR Audio Seminars” in the subject line and
the requested audio session, date and care setting listed in the body
of the e-mail. Texas
Health Care System to Install Electronic Patient Records Baylor Health
Care System, the Dallas-Fort Worth based non-profit health care system,
plans to purchase a $119 million electronic patient record system that
will follow patients through the hospital system’s multiple locations
and into the computers of Baylor-affiliated physicians. Using technology
from Florida-based Eclypsis Corp., patients will fill out an initial form
and then doctors will be able to pull up records from any visit made to
a Baylor facility. The EHR would also contain information about prescriptions,
prompting doctors to make sure they are not administering medicines that
could have adverse effects. For more
info, www.baylorhealth.com.
Aetna
Software Catches Rx Errors A computer
program to prevent medical errors, piloted by health insurance companies
since October 2002 in the New York-New Jersey area, will serve an estimated
1 million members this year, as the program expands to the west, southwest
and north central regions. The software,
CareEngine, continually tracks claims coming in from doctors, hospitals,
pharmacies and labs. The system also sees lab test results, past claims
and diagnoses and searches for variances from about 2,000 rules. CareEngine
looks for practices that should have occurred but did not, such as lab
tests, X-rays or drug prescriptions, and is also designed to find errors
that should not have occurred but did, such as prescribing a combination
of drugs that could harm a patient. Examples of how the software has flagged
potential medical errors includes: Aetna has
been using the program, calling it MedQuery, and Empire Blue Cross Blue
Shield in New York also uses the software, calling it Systematic Analysis
Review and Assistance. Aetna has been applying MedQuery to members in
its Medicare HMO and to an increasing number of fully-insured accounts.
For more
info, www.aetnapharmacy.com.
A preliminary
report from the Healthy Florida Foundation has recommended to Florida
Gov. Jeb Bush that the state adopt a universal electronic medical records
system within five years. The Healthy
Florida Foundation—a task force of consumers, physicians, insurers,
nurses, and advocacy organizations—studied and analyzed American’s
health care delivery system, identifying structural changes that will
offer long-term solutions in quality, affordability and accessibility.
For more
info, www.healthyfloridafoundation.org. Kaiser
Conducts Public Survey on Knowledge of Medicare Bill The Kaiser
Health Poll Report survey, conducted December 3-7 (after the Medicare
bill was passed by Congress but before it was signed by President Bush),
found that 65% of those surveyed reported closely following stories about
debates in Congress on the Medicare prescription drug bill. When asked
whether this bill had passed Congress or not, 39% correctly answered that
the bill passed, while 13% said it did not pass. Around half the public
(49%) said they did not know. Among seniors surveyed, 50% correctly answered
that the bill passed, 18% incorrectly said it did not pass and three in
ten 31% said they did not know. In order
to see if these results changed after the bill the president signed the
bill into law, Kaiser fielded a separate survey from December 10-14, 2003.
At that time, 44% of adults said they followed the story closely. Similar
to the first survey, 40% knew that the bill had passed and was signed
into law, while 19% said it did not pass and 41% said they did not know.
Knowledge
among seniors increased somewhat after the bill was signed, with 59% saying
the bill had passed. Nearly two in ten seniors, 18%, incorrectly answered
that the bill had not passed, and 23% said they did not know. For more
info, http://headlines.kff.org/healthpollreport/hni/detail/2.php.
VHA
Software May Be Used to Help Developing Countries WorldVistA,
a not-for-profit group seeking to make health care technology available
globally, is seeking to take medical records software from the U.S. Department
of Veterans Affairs and use it for developing countries. BBC News
Online reported that the software, which incorporates electronic medical
records and computerized physician order entry, is ideal for developing
countries because there are no upfront costs or license fees. WorldVistA
is talking to Malaysian officials about running a pilot program, but acknowledged
that the software can be difficult to implement and maintain. eHealth
Initiative: 42 States, 130 Groups Express Interest in EHI Janet M.
Marchibroda, executive director of the Washington D.C.-based eHealth Initiative
said during the organization’s third annual meeting that 130 groups
across the country report they are read to move forward with electronic
health information (EHI) projects designed to improve patient safety and
quality. Marchibroda
said 134 groups in 42 states and the District applied for a share of the
$4 million grant received from the Health Resources and Services Administration
Office for the Advancement of Telehealth. The Bureau
of National Affairs reported that the foundation presented several key
findings based on information submitted by the groups: For more
info, www.ehealthinitiative.org.
Members of
the American Academy of Family Physicians may purchase electronic medical
records for up to half the cost of the direct vendor price, under an initiative
designed to encourage doctors to adopt EMRs. The initiative,
“Partners for Patients,” allows physicians to purchase software
from seven vendors at discounts of 15-50%. David Kibbe, director of AAFP’s
Center for Health Information Technology, told American Medical News that
AAFP started the program because it felt EMRs would improve patient safety
and patient care. Startup costs associated with the program, which can
range from $25,000-$50,000 per physician, have been cited as the biggest
roadblock. Less than 10% of AAFP’s 94,000 members currently use
EMRs, although thousands have expressed interest in them. For more
info, www.aafp.org.  Home :: Inside AHQA :: For The Media :: Public Policy :: Advancing Quality :: Quality Connections :: SiteMap
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