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Physicians
Need to Recognize Behavioral, Social Factors in Patient Care, IOM Report
Says
AHRQ:
Better Communication Yields Better Diabetes Self-Care
Study
Links HIPAA to Lower Participation Rates, Increased Costs in Heart Attack
Research
HSC
Study Finds Regulatory Forces Drive Hospital Patient Safety
URAC:
PPOs Use Diverse Means of Preventive Care For Patients
USP
Book Aims to Help Health Care Systems Lower Medical Errors
Study:
Pay-for-Performance Improves Physician Quality of Care
EHR
Voting Began March 18
Allscripts
to Offer EMRs to AAFP
Physicians
Need to Recognize Behavioral, Social Factors in Patient Care, IOM Report
Says
A new study
from the Institute of Medicine concludes that medical education must better
prepare physicians to recognize and respond to behavioral and social factors
that affect patient care.
With behaviors
such as smoking and physical inactivity contributing to half of deaths
and illnesses in the U.S., the report says physicians must be equipped
to identify and influence patients to change risky behaviors.
The IOM report
finds that optimal care also depends on physicians’ understanding
of psychological and social factors, such as spiritual beliefs, culture
and socioeconomic status, which play a significant role in chronic disease
risk and recovery. The report outlines a list of topics it says should
be included in medical school curricula, including the mind-body connection,
patient behavior, physician-patient interaction, social and cultural issues
in health care, and health policy and economics.
The report
also recommends the creation of a national database to better track medical
school behavioral and social science curricula and teaching techniques;
the establishment of awards programs to promote faculty career development
and fund demonstration projects aimed at enhancing medical school curricula;
and increased behavioral and social science content on the U.S. Medical
Licensing Examination.
For more
info, www.nationalacademies.org.
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AHRQ:
Better Communication Yields Better Diabetes Self-Care
Diabetes
patients enhance their self-care when doctors improve patient-provider
communication, whether specifically related to diabetes or directed toward
general health communication, according to research supported in part
by the Agency for Healthcare Research and Quality.
The study,
“Dimensions of patient-provider communication and diabetes self-care
in an ethnically diverse population,” by Dr. Piette, Dean Schillinger,
M.D., Michael B. Potter, M.D., and Michele Heisler, M.D., M.P.A., appears
in the August 2003 Journal of General Internal Medicine 18, pp.
624-633.
Piette and
his colleagues conducted telephone interviews with 752 adult diabetes
patients, who received diabetes care at one of three Veterans Affairs
health care systems, one county care system, or one university-based health
care system. They asked patients about the type and frequency of diabetes-specific
information, such as diet, exercise, foot care, and medication adherence.
Researchers also inquired about general health information communicated
to them by their primary care provider over the past year as well as diabetes
self-care within the past seven days.
After controlling
for other factors, the predicted probability of daily or almost daily
foot checks increased from 63% for patients who received both poor general
communication and poor diabetes-specific communication to 91% for those
who received the best communication of both types of information.
The predicted
probability of taking hypoglycemic medications improved similarly in relation
to improved physician communication of both types of information. Patients’
predicted probability of following their recommended diet daily increased
from 3% among patients with poor communication on both dimensions to 28%
among patients with the best possible combination of communication scores.
The probability of daily exercise also increased with better physician
communication of either type of information.
For more
info, www.sgim.org.
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Study
Links HIPAA to Lower Participation Rates, Increased Costs in Heart Attack
Research
Heart attack
patients who agreed to participate in research after leaving the hospital
dropped from 96.1% to 38.5% because of compliance with the Health Insurance
Portability and Accountability Act (HIPAA), research indicates.
Researchers
at the University of Michigan Cardiovascular Center previously used a
verbal privacy authorization, obtained when they called patients at home
months after they left the hospital. HIPAA requires written authorization
from a patient before he or she can be contacted to gather personal health
information for a research study.
Following
a change from verbal consent to a HIPAA-compliant written authorization
that had to be mailed to patients and mailed back, researchers found a
sizable drop in the percentage of patients who gave consent to be called.
The participation drop from 96.1% to 38.5%, meant that the population
was not as representative of the entire population of patients the researchers
wanted to study, which the cardiologists felt could bias the results.
“On
top of this impact on the quality of data, the costs involved in asking
for this written authorization were substantially larger than those for
the verbal system,” says Eva Kline-Rogers, M.S., N.P., who helped
lead the study. “To get consent from one patient, we calculated
we’d spend $14.50 per patient in the first year of the study for
computer, training, staff, administrative and mailing costs, and $7.50
each year afterward.”
To avoid
the mailed authorization approach, by asking patients for consent while
they were still in the hospital, would be cost-prohibitive and labor-intensive,
she adds.
Compliance
with HIPAA, which stands for the Health Insurance Portability and Accountability
Act, became mandatory on April 14, 2003, though voluntary compliance was
encouraged before that. The U-M team carried out its study during that
voluntary compliance period, using guidance from U-M clinical research
officials about what they would have to do to comply with HIPAA.
“The
balance between protecting patient privacy, while at the same time we
strive to learn about the best methods by which to treat patients after
certain types of conditions and/or treatments, is delicate,” says
Kim Eagle, M.D., clinical director of the U-M Cardiovascular Center and
senior author on the study. “If long-term patient outcomes are to
be used to ‘inform’ current care, we must develop better ways
of working with patients and regulatory agencies to define the proper
balance.”
Kline-Rogers
and her colleagues at the U-M Cardiovascular Outcomes Research and Reporting
Program set out to obtain written consent from heart patients six months
after they left the U-M hospital following treatment for acute coronary
syndrome – either a heart attack or unstable angina episode.
They obtained
the list of patients retrospectively, by looking at the discharge diagnosis
for each patient. This is allowed under HIPAA as part of preparation for
a research study.
Between Sept.
1, 2001 and March 31, 2003, they sent letters and consent forms to the
patients, and called those who responded to ask questions about their
health.
Because the
HIPAA compliance mandate was not yet fully in effect, they were also able
to call those patients who didn’t mail back their consent form,
to try to obtain verbal consent. They could also check records to see
if patients on the HIPAA-compliant lists had died.
They then
compared the rates of authorization and several demographic characteristics
with those from patients who had been contacted for the same purpose between
May 1, 1999 and August 30, 2001, before HIPAA.
In addition
to Kline-Rogers, the study’s authors are David Armstrong, a Cornell
University student who performed much of the data gathering and analysis;
Sandeep Jani, Jianming Fang, M.D., Anchal Sud, Krishna Rangarjan, Shaneen
Doctor, Bruce C. Rogers, Debra Smith, and Kim Eagle, M.D.
For more
info, www.med.umich.edu/opm/newspage/2004/privacylaws.htm.
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HSC
Study Finds Regulatory Forces Drive Hospital Patient Safety
A study examining
factors driving hospital patient safety initiatives concludes that quasi-regulatory
forces such as the Joint Commission on Accreditation of Healthcare Organization,
not market forces, are having the greatest impact on hospitals’
patient-safety efforts. The study argues that continued public and private
effort is required to maintain the momentum for medical error reduction
as health care costs continue to rise.
The study,
“What Is Driving Hospitals’ Patient-Safety Efforts?”
was conducted by researchers at the Center for Studying Health System
Change and appears in the March/April 2004 edition of Health Affairs.
Authors of
the article conducted four rounds of site visits in twelve U.S. metropolitan
areas, initially selected at random. During the fourth round, 1,000 semi-structured
interviews were conducted between September 2002 and May 2003.
Responses
to various interview questions were coded to assess whether various subgroups
have similar or different perspectives on hospitals’ patient-safety
activities. In addition to the interviews, researchers used data from
two complementary surveys: a Community Tracking Study patient safety survey,
and the Leapfrog Group’s publicly reported survey data from hospitals
in five of the twelve CTS markets for the same time period as the CTS
site visits.
The interview
and CTS patient survey data indicated that hospitals’ major patient-safety
initiatives are primarily intended to meet JCAHO requirements. Although
professional and market initiatives have also facilitated improvement,
hospitals in local markets reported that they have had less impact on
hospitals’ behavior to date.
“Continued
public and private effort is required to maintain the momentum for medical
error reduction as health care costs continue to rise, and to develop
the necessary infrastructure and know-how. These efforts must use professional,
regulatory, and market mechanisms to stimulate change and accountability
and to help hospitals and clinicians overcome organizational and technical
barriers,” the authors wrote.
For more
info, http://content.healthaffairs.org/cgi/content/full/23/2/103.
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URAC:
PPOs Use Diverse Means of Preventive Care For Patients
Preferred
provider organizations (PPOs) and medical management organizations (MMOs)
employ diverse approaches to preventive care services, according to a
report this week by URAC. The study was funded by the National Business
Coalition on Health (NBCH) as part of a cooperative agreement from the
Centers for Disease Control and Prevention (CDC).
URAC identified
a number of creative strategies used by MMOs and PPOs to improve delivery
of preventive care outside of an HMO delivery system. Factors that influence
PPO and MMO delivery of preventive services include:
- Purchaser
demand: one or more purchasers supports the project
- Community
leadership: the organization is part of an ongoing initiative
-
Benefit package requirements: the organization has enough leverage
to require specific benefits
-
Guideline-driven initiatives: the organization makes prevention
assessment seamless through automated decision support
-
Web-based outreach and intake: the organization uses the Web
to educate and engage
-
Evidence of ROI: the organization has a compelling argument
for prevention services
“PPOs
are well positioned to facilitate a dialogue with purchasers about the
value of including preventive care benefits in benefits packages,”
said Karen Greenrose, President of the American Association of Preferred
Provider Organizations (AAPPO). “It is critical however, that PPOs
have the tools and information to make the case for prevention, and the
results of URAC’s study will provide a resource for PPOs and purchasers
to support decisions that will improve health outcomes and potentially
decrease costs.”
URAC also
recommends that the CDC continue its emphasis and outreach to consumers
and purchasers regarding the importance of prevention:
Measurement:
Develop models for measuring preventive services delivery where there
is no set “denominator” of all eligible beneficiaries
Cost: Develop models for provider targeted pay-for-performance
in PPO settings
Coordination and Accountability: Develop better understanding
of employer based prevention initiatives and how the health system can
support activities underway in workplace settings
Improving Demand in All Sectors: Employ enhanced communications
research to better understand prevention drivers for consumers, providers,
purchasers and purchasing coalitions
Developing Tools and Other System Supports: Develop
models and toolkits for model preventive services benefits packages
“Because
employers face the burden of increasing costs of health care and are recognizing
the importance of preventive health services, the National Business Coalition
on Health is extremely interested in promoting creative strategies to
improve health outcomes in all forms of care delivery, including PPO plans
and networks,” said Andrew Webber, president and CEO of the National
Business Coalition on Health.
“This
study reflects an important dialogue between purchasers, especially employers,
who often utilize less integrated health care organizations to provide
services to their employees and other stakeholders,” said Garry
Carneal, URAC president and CEO. “With CDC emphasis on preventive
care, the results will help PPOs and MMOs add value to customer offerings
by increasing awareness of strategies they utilize to enhance delivery
of clinical preventive services.”
Carneal added,
“URAC’s leadership position in accrediting PPO and medical
management organizations gives us a unique perspective to promote widespread
adoption of prevention strategies and magnify their impact on health outcomes.”
For more
info, www.urac.org.
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USP
Book Aims to Help Health Care Systems Lower Medical Errors
United States
Pharmacopoeia released a case study book this month, featuring actual
hospital medication errors and steps taken to prevent similar mistakes.
Diane Cousins,
vice president of the Center for the Advancement of Patient Safety at
USP said the book, Advancing Patient Safety in U.S. Hospitals: Basic
Strategies for Success, was written to help hospitals and health
care systems reduce medication errors and facilitate a culture change
that embraces error reporting systems
The case
studies draw from interviews with more than two dozen health care administrators
and practitioners, who represent large and small U.S. hospitals. Their
accounts describe the steps they have taken to change their hospitals’
cultures of blame; how they convinced staff members to report more medication
errors; how error reports are analyzed to identify trends; and how their
hospitals have instituted process changes to reduce medication errors.
“Without
error reporting, we cannot identify and implement the system and process
changes necessary to eliminate medication errors,” Cousins said.
“Many of the first-person accounts in this book discuss situations
familiar to many health care practitioners. We believe hospitals and health
care institutions nationwide will find the book’s information a
valuable resource and tool for building a safer health care system.”
In addition
to first-person accounts, USP offers 10 recommendations to improve medication
safety in health facilities. Among the recommendations: adopt a nonpunitive
policy for reporting potential and actual medication errors; create open
lines of communication among departments and disciplines; and provide
incentives for participating in the medication safety reporting system.
For more
info, http://store.usp.org.
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Study:
Pay-for-Performance Improves Physician Quality of Care
A four-year
study conducted by Health Benchmarks (HBI) indicates that the implementation
of a physician pay-for-performance program resulted in improved quality
of care.
HBI President
and CEO Dr. Antonio Legorreta, plans to present this work during a concurrent
session of the 10th annual American Association of Health Plans-sponsored
Building Bridges Conference.
Legorreta’s
presentation, “Improving PPO Physician Adherence to Evidence-based
Care: A Four-year Longitudinal Evaluation of an Incentive Program,”
addresses the impact of a pay-for-performance program implemented with
the Hawaii Medical Service Association (HMSA). The program, which has
grown to include more than 70 evidence-based quality indicators, encourages
and rewards physicians who adhere to appropriate care guidelines.
According
to Legorreta, many health plans and organizations have believed in the
promise of pay-for-performance for several years, but specific results
proving the impact of these programs had not been demonstrated. He says
there is now compelling evidence in support of performance-based reimbursement
models which work with physicians within a collaborative framework.
The results
from HBI’s study will be presented in a concurrent session titled,
The Nature of Evidence and Experience. The conference will take place
in Miami, Florida on April 2.
For more
info, www.healthbenchmarks.com.
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EHR
Voting Began March 18
The 30-day
ballot period for a national standard for electronic health records began
on March 18.
The model,
developed by the standards group Health Level 7 (HL7), was approved by
79% of voters in a straw poll at last month’s Healthcare Information
and Management Systems Society meeting, and lists 130 EHR functions, compared
with 1,600 in the first model that was rejected last fall as too complicated.
If the new
version receives a two-thirds positive vote, the document will then be
submitted to the American National Standards Institute (ANSI) as a draft
standard for trial use for a period of up to 24 months. This will be announced
to the industry at large and HL7 will encourage the industry to download
and use the draft standard and report their findings back to HL7. Once
industry feedback has been included, the document will be updated and
re-balloted and then published as a normative standard and submitted to
ANSI for approval.
Voting is
conducted on the HL7 Web site and is open to members of the group; nonmembers
can pay a $100 administrative fee to vote. The ballot will be open for
comment until April 16, and results will be announced at an HL7 meeting
May 2-7 in San Antonio, Texas.
Individuals
interested in participating in the second ballot of the HL7 Electronic
Health Record-System Functional Model can register to vote at www.hl7.org/ehr/ballot/signup.asp
For more
info, www.hl7.org/EHR
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Allscripts
to Offer EMRs to AAFP
Allscripts
Healthcare Solutions announced March 23 its participation in the American
Academy of Family Physicians (AAFP) initiative to provide electronic medical
record technology to medical practices.
Allscripts
Healthcare Solutions (AHS), a clinical software provider for physicians,
will bring its TouchWorks EMR and IMPACT.MD document imaging and management
solution to the AAFP Partners for Patients initiative. The goal of this
initiative is to facilitate access to affordable, robust electronic medical
record technology for the 93,700 physician members of AAFP.
David C.
Kibbe, M.D., director of the AAFP Center for Health Information Technology,
said information technology offers the health care industry tremendous
clinical and financial benefits, which must now be expanded to more practices,
regardless of size.
In its announcement,
Allscripts stated it will work with AAFP to provide affordable, compatible,
interoperable, and secure EMR solutions. These solutions are designed
to achieve compatibility through efforts to standardize connectivity interfaces
between office-based systems and key information resources for electronic
prescribing, laboratory result reporting and practice management or hospital
information systems. AHS also will work with AAFP to develop interoperability
standards, such as the Continuity of Care Record, to enable seamless data
exchange among physicians, other providers and patients.
For more
info, www.allscripts.com.
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