Quality Update for July 1, 2004

HHS to Unveil Health IT Plan July 21 HCA Chief Calls for Congressional P4P Board Perceptions of Medical Error Vary, Study Finds Article Looks at Nursing Home Disparities Many Women Not Getting Mammograms Report: more health care workers need flu shots Commonwealth Fund Issues Disparities Report Leapfrog Reward Compendium Online 3 Mass HCOs Build Patient Safety Technology Patient Safety Handbook Published HHS to Unveil Health IT Plan July 21 Health and Human Services Secretary Tommy G. Thompson announced that the first installment of a national health information technology plan will be delivered July 21 when the Department convenes at a conference in Washington, D.C., to accelerate progress toward electronic health records and other benefits of health information technology for Americans. The strategic plan was mandated by President Bush in an April 27 executive order that also established the new Office of the National Coordinator for Health Information Technology at HHS. The order requires a report within 90 days on progress toward a national strategy for harnessing health information technology. The report, to be presented by Secretary Thompson and National Coordinator David J. Brailer, M.D., Ph.D., will outline shared responsibilities of the public and private sectors in achieving the benefits of health information technology (HIT). The report will put forth a set of guiding principles, core goals and corresponding actions that will help guide the development of a national action plan. For more info, www.hhs.gov. HCA Chief Calls for Congressional P4P Board Jack O. Bovender, Jr, chairman and CEO of health care provider HCA, called for Congress to establish a board that would create a standard set of quality measures for the growing number of pay- for-performance programs, Modern Healthcare reported in an online update. Bovender, who was speaking at the Healthcare Financial Management Association's 2004 Annual National Institute in Nashville, said without a standardized board, that health care providers would incur higher administrative costs to comply with the different data requirements for the pay-for-performance programs “It would be entirely appropriate and productive for Congress to step in and form a board to say here’s how we’re going to come up with measurements and here's how we can equally apply them across all providers,” Bovender said, according to Modern Healthcare. For more info, www.modernhealthcare.com. Perceptions of Medical Error Vary, Study Finds A study in the American Jouranl of Nursing found that health care providers’ professional roles as well as preconceived notions of what constitutes an error can heavily influence their understandings of what constitutes a medical error. The study examined the organizational processes used to recognize medical errors and assign responsibility for them to resolve patient-safety issues in 29 small rural hospitals over a three-year period. The authors propose that “a systems approach to patient safety” be adopted, one in which responsibility for safety is shared by all members of the health care team. For more info, www.ajnonline.com. Article Looks at Nursing Home Disparities An article that looks at health care disparities in the nursing home setting argues that public reporting of quality indicators may result in driving poor homes out of business and will disproportionately affect nonwhite residents living in poor communities. The article, “Driven to Tiers: Socioeconomic and Racial Disparities in the Quality of Nursing Home Care, notes that nursing home care,” presents the argument that nursing home care is a two-tiered system, with the nearly 15% of U.S. non-hospital based nursing homes that serve predominantly Medicaid residents have fewer nurses, lower occupancy rates, and more health-related deficiencies. For more info, www.milbank.org. Many Women Not Getting Mammograms About one in 20 women consistently utilized annual mammography over ten years and received the mortality benefits of screening mammography, according to a study in the online CANCER, a peer reviewed journal of the American Cancer Society. Dr. James Michaelson of the Massachusetts General Hospital (MGH) and colleagues from both MGH and the Harvard Medical School reviewed data from 72,417 women who received screening mammograms at the MGH Avon Comprehensive Breast Center from 1985 to 2002. They analyzed the data for trends within subgroups based on race, age, prior history of breast cancer and socioeconomic status and used a computer simulation model of breast cancer to estimate the health consequences of various usages of screening. Overall, only 6% of women utilized ten mammograms. The median number of mammograms received was only five. More important, an analysis based on age, race, socioeconomic status and past history of breast cancer, found no single group completed all ten recommended screenings. Disparities in usage were found according to race and socioeconomic status with Hispanic, African American, and Asian women as well as women from lower economic status receiving fewer mammograms. For more info, www.interscience.wiley.com/cancer-newsroom. Report: more health care workers need flu shots Unvaccinated health care workers can be a key cause of influenza outbreaks in health care settings, but fully 64%of health care workers nationwide do not get annual flu shots, according to a report. The American Medical Association and the National Foundation for Infectious Diseases, along with other health care groups, have created “Improving Influenza Vaccination in Health Car Workers: Strategies to Increase Protection for Workers and Patients,” a 21-page monograph that provides strategies health care institutions can use to improve annual influenza immunization rates among employees. The monograph also provides information on the impact of influenza on health care workers and patients and suggestions on how to improve health care workers' knowledge of and attitudes toward vaccinations. For more info, www.nfid.org. Commonwealth Fund Issues Disparities Report The Commonwealth Fund has issued a report outlining a range of initiatives that states and localities are using to end racial and ethnic health disparities. The report also offers strategies for state policymakers and health leaders seeking to improve health care coverage, access, and outcomes for minorities. In A State Policy Agenda to Eliminate Racial and Ethnic Health Disparities, John A. McDonough, Dr.P.H., executive director of the Massachusetts consumer health advocacy organization Health Care for All, Brian Gibbs, Ph.D., of the Harvard School of Public Health, and colleagues note that states are key players in the effort to eliminate disparities. The report provides a comprehensive review of such promising practices as states using their purchasing power to promote change, targeting insurance coverage expansion to low-income families, and initiatives targeting health conditions - like asthma and diabetes - that disproportionately affect minorities. The report recommends the creation of a national coordinating council to promote continuing state based activities to conduct and support research on best practices, develop strategies to advise states, and educate state officials and other stakeholders on developments in eliminating disparities. For more info, www.cmwf.org/programs/minority/mcdonough_statepolicyagenda_746.pdf Leapfrog Reward Compendium Online The Leapfrog Group, with support from The Commonwealth Fund and The Robert Wood Johnson Foundation, has developed a Web-based compendium of incentive and reward programs aimed at improving health care in both in-patient and out-patient settings. The Leapfrog Incentive and Reward Compendium is designed to help raise awareness among purchasers, health plans, and health care providers about innovative schemes that are already in place to improve the quality and affordability of health care. The Leapfrog Incentive and Reward Compendium documents and categorizes both financial programs, such as those that reward providers with quality bonuses, and non-financial programs, such as those that reward providers with public recognition. Currently, the Leapfrog Compendium details 77 programs from around the country, including 17 that incorporate Leapfrog's performance measures. The majority of the programs included in the Compendium are initiated by health plans, purchasers, or purchasing coalitions and target hospitals, physicians, health plans, and consumers. For more info, www.leapfroggroup.org/ircompendium.htm. 3 Mass HCOs Build Patient Safety Technology Three health care organizations in central Massachusetts’ leading health care organizations have entered into a partnership to pioneer technology that they said will significantly improve patient safety and quality of health care delivery, and reduce health care costs. SAFE Health Info (Secure Architecture For Exchanging Health Information) will use advanced technology to connect clinical data and information systems among individual health care organizations, enabling clinicians to appropriately and quickly access patients' medical records in emergency and ambulatory settings. In collaboration with Hewlett-Packard, Fallon Clinic, Fallon Community Health Plan and UMass Memorial Health Care will design and build a software prototype to demonstrate the viability of exchanging health care information among the three organizations. Once the prototype is complete, SAFE Health Info will be able to securely provide updated patient medical history to clinicians at critical points of care. For more info, www.fchp.org or www.umassmemorial.org. Patient Safety Handbook Published Sudbury, Mass, Jones & Bartlett Publishers have released “The Patient Safety Handbook,” edited by Barbara J. Youngberg and Martin J. Hatlie. According to a review in the Journal of the American Medical Association, “The Patient Safety Handbook touches on nearly every appropriate facet of accident, error, patient harm, organizational culture, ethics, accountability, safety, industrial hygiene, and legality. Perhaps it is too inclusive.” Many authors contributed to the 779-page compendium, which is on sale for $99.95, ISBN 0-7637-3147-1. Back to top

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