Quality Update for October 08, 2004

Dartmouth Studies Show Wide Variations In Hospital Care And Outcomes For Chronically Ill Medicare Patients Minority Patients Wait Longer for AMI Treatment, Yale Study Finds Studies Strengthen Link Between Kidney, Heart Diseases IT Use Varies Widely, Study Finds Baylor Installs Self-Service Kiosks Calvary Offers Two New Programs Public Wants Help, Health Care Reform, Report Finds AHRQ Studies Economic Incentives for Preventive Care NCQA Annual Quality Report Favors Public Reporting FACCT to End Operations GAO Testimony Available Online Dartmouth Studies Show Wide Variations In Hospital Care And Outcomes For Chronically Ill Medicare Patients Medicare patients with similar chronic conditions receive strikingly different care, even among hospitals identified as “best” for geriatric care by the magazine U.S. News & World Report, according to 20 Dartmouth Medical School studies. The studies, featured in the Oct. 7 Web-exclusive edition of the journal Health Affairs, show that the frequency of physician visits, the number of diagnostic tests, and rate of hospital and intensive care unit (ICU) stays vary markedly. The authors looked at variations in care for more than 90,616 patients age 65 and older sufferin from solid tumor cancers, congestive heart failure, and chronic obstructive pulmonary disease, comparing the illness-adjusted frequency of physician visits, hospitalizations, and ICU stays. The studies show that a higher intensity of care and higher level of spending are not associated with better quality or longer survival times even in the most renowned teaching hospitals. In fact, there is evidence that a very high intensity of care for people with certain terminal medical conditions might hasten death, the researchers report. New findings identify by hospital where Medicare enrollees are receiving much more intensive care for common medical conditions, raising questions about usual methods of identifying “best” hospitals. Copies of the Oct. 7 Web-Exclusive articles on medical practice variation will be available until Oct. 22 at www.healthaffairs.org. For more info, Jon Gardner, Health Affairs, 301-347-3930, or jgardner@projecthope.org. Back to top Minority Patients Wait Longer for AMI Treatment, Yale Study Finds Black and Hispanic patients experience marked delays in heart attack treatment compared with whites, according to a report published in the Journal of the American Medical Association. Yale researchers studied about 110,000 heart attack patients treated in more than 1,000 hospitals across the country, revealing that Hispanic or African American patients have a 10-20% longer wait time in getting the proper emergency treatment for restoring blood flow to the heart. Time to treatment in heart attacks is very important to patient survival and is an indicator of quality of care used by the Centers for Medicare & Medicaid Services and the Joint Commission on Accreditation of Healthcare Organizations. Further, the longer treatment times among racial and ethnic minority groups are due in large part to the quality of the hospitals in which they are treated. “The findings suggest that we may have dual systems of care, in which many minority patients are less likely to receive treatment in the higher quality hospitals. Eliminating disparities might best be achieved by efforts to improve quality at poorer performing hospitals and ensuring that all patients have access to high-quality hospitals,” said Harlan M. Krumholz, MD, professor of medicine at Yale and senior author of the study. The study is titled “Racial and Ethnic Differences in Time to Acute Reperfusion Therapy for Patients Hospitalized With Myocardial Infarction.” For more info, http://jama.ama-assn.org. Back to top Studies Strengthen Link Between Kidney, Heart Diseases A pair of new epidemiology studies confirms that chronic kidney disease independently increases the risk of developing cardiovascular disease, even among people with early kidney disease and after considering other risk factors such as diabetes, hypertension and high cholesterol. The studies, which appear in the New England Journal of Medicine, followed more than 1.1 million adults, whose average age was 52, from the Kaiser Permanente Renal Registry in San Francisco for nearly three years. Led by Alan S. Go, MD, the investigators found that when kidney function (GFR) dropped, the risk of death, cardiovascular events such as heart disease and stroke, and hospitalization increased. Compared to patients whose GFR was at least 60 (ml per min. per 1.73 m2): The increased risk of death ranged from 17% in those whose GFR was between 45 and 59 to about 600% in those whose GFR was less than 15; The increased risk of CVD events ranged from 43% in those whose GFR was between 45 and 59 to 343% in those whose GFR was less than 15, and; The increased risk of hospitalization ranged from 14% in those whose GFR was between 45 and 59 to 315% in those whose GFR was less than 15. An ongoing study supported by NIDDK will help further explain the connection between CKD and CVD and should lead to improved management of these diseases. Investigators in the Chronic Renal Insufficiency Cohort study are looking at earlier kidney disease than most trials have previously studied and are conducting the most thorough review to-date of the relative impact of known risk factors for kidney and heart diseases. For more info, http://content.nejm.org. Back to top IT Use Varies Widely, Study Finds While there’s wide enthusiasm for harnessing the power of information technology to improve U.S. medical care, fewer than a quarter of physicians in 2001 could generate electronic treatment reminders for use during patient visits and about 10% could write electronic prescriptions, according to a national study released by the Center for Studying Health System Change. The study examined whether physician practices used computers or other information technology for the following five clinical functions: obtaining treatment guidelines, exchanging clinical data with other physicians, accessing patient notes, generating treatment reminders for the physician’s use and writing prescriptions. Nearly 60% of physicians in traditional practice settings—primarily solo or relatively small group practices where the vast majority of Americans receive care—reported that their practice used information technology for no more than one of the five clinical functions. Highest levels of IT support for patient care were found in staff- and group-model health maintenance organization practices, followed by medical school faculty practices and large group practices. Overall rates of information technology adoption may have increased since 2001, but the variation in IT adoption by practice setting is unlikely to have changed, the study concluded. Of almost 70% of physicians in traditional practice settings—solo, small groups with up to 50 physicians or practices owned by hospitals—were least likely to be in practices using information technology, with IT adoption rates ranging between 8-50% for the five functions examined. “The promise of information technology to improve patient care remains just that—a promise—in most physician practices across the country,” HSC President Paul B. Ginsburg, PhD, said. While practice setting, especially size, was clearly the most important factor in IT adoption, other factors, such as physician age, specialty, and whether the practice was in an urban or rural area, played relatively minor roles as underlying drivers of IT adoption. For more info, www.hschange.org/CONTENT/708. Back to top Baylor Installs Self-Service Kiosks Pilot Seeks to Increase Mammograms Baylor Health Care System in Dallas has introduced Galvanon’s self-service MediKiosks to streamline the patient check-in process, reduce administrative costs and enhance the total patient experience as part of its system wide clinical transformation initiatives. The MediKiosks are located at Sammons Cancer and Breast Imaging Center at Baylor University Medical Center in Dallas. The self-service MediKiosk Solutions will expedite the check-in process for patients who simply have to swipe a driver’s license, credit card or membership card at the kiosk for identification. It also alleviates all manual data and the repetitiveness of filling out forms each time. Once checked-in, the kiosks allow patients to verify appointments, sign consent forms and even pay their co-pay. Randy Fusco, corporate director of Baylor’s e-Strategies group, said conducting pilots like these allow Baylor to quickly determine the potential value to customers. Baylor is currently using Galvanon’s Customer Value Management Solutions to help with online bill paying. The CVM solutions extend the use of existing patient information in the hospital to enhance the level of service Baylor can provide for its patients and physicians. For more info, www.baylorhealth.com or Jennie Moore, 214-820-4565, jenniem@baylorhealth.edu. Back to top Calvary Offers Two New Programs Calvary Hospital, the nation’s only fully accredited acute care hospital providing palliative care to adults with advanced cancer, has introduced two programs to ensure that patients and families receive the highest quality care. The Family Care and Cancer Prevention Center opened at the Calvary Hospital Bronx Campus in June 2004. The center provides support to patients’ families, offering programs focused on emotional and spiritual support, respite and relaxation, and guidance and information about cancer prevention. Lecture series about health and wellness will be offered to the community at large. The Calvary Hospital Center for Palliative Wound Care, under the auspices of Calvary’s Palliative Care Institute recently began accepting patients on an outpatient basis. Led by expert wound care specialist, Dr. Oscar Alvarez and his team, hundreds of patients will be given treatment for complex wounds. Inpatients, hospice, home care and outpatients will be treated by the Center’s team. For more info, www.calvaryhospital.org or Noreen McNicholas, director of public affairs, nmcnicholas@calvaryhospital.org. Back to top Public Wants Help, Health Care Reform, Report Finds The Kettering Foundation released a report that finds citizens are anxious for health care reform, believe they should be rewarded for healthy behaviors, want ombudsmen provided to assist them in navigating a system that has become too complex for the layman to manage, and believe government needs to play a key role in bringing interested parties together to work toward a solution. The report summarizes the findings of a series of public forums on possible approaches to reforming the nation’s health care system. According to the report, more than 1,000 citizens representing 44 states participated in the forums over the past year. For more info, www.nifi.org/stream_document.aspx?rID=2407&catID=6&itemID=2404&typeID=8. Back to top AHRQ Studies Economic Incentives for Preventive Care The Agency for Healthcare Research and Quality released a report summary on “Economic Incentives for Preventive Care.” AHRQ’s Minnesota Evidence-based Practice Center reviewed evidence to evaluate the impact of explicit economic incentives targeted at motivating providers and consumers to promote the adoption of preventive health behaviors. The report cautiously indicates that consumer-focused economic incentives are effective in the short run for simple preventive care; however, there is insufficient evidence to suggest that economic incentives are effective for promoting long-term lifestyle changes required for health promotion. For more info, www.ahrq.gov/clinic/epcsums/ecincsum.htm. Back to top NCQA Annual Quality Report Favors Public Reporting The National Committee for Quality Assurance has released its annual State of Health Care Quality report, which finds that the quality of care delivered by health plans that publicly report on their performance improved markedly last year. Yet the U.S. health care system as a whole remains plagued by deadly “quality gaps” that contribute to 42,000 to 79,000 avoidable deaths every year. The findings suggest that the system is deeply polarized, delivering excellent care to some people, and generally poor care to many others. NCQA’s annual also found that nearly 66.5 million avoidable sick days and more than $1.8 billion in excess medical costs can be traced to the health care system’s routine failure to provide needed care. “The data we have tell a great story – health care quality for some is improving consistently and dramatically,” said NCQA President Margaret E. O’Kane. “But we only have data for accountable health plans. Why don’t we have performance data for the other 75% of the U.S. health care system? All types of health plans, hospitals and doctors should report on their performance. How else can we make informed choices?” This year’s report also highlights various efforts aimed at improving health care, including several physician and hospital pay-for-performance projects, which are seen by many experts as a key part of the solution to the nation’s health care woes. For more info, www.ncqa.org/index.htm. Back to top FACCT to End Operations David Lansky announced that effective Sept. 1, he has stepped down as president of FACCT, the Foundation for Accountability which seeks to improve health care by advocating for an accountable and accessible system where consumers are partners in their care and help shape the delivery of care. Lansky, who will remain on the FACCT Board of Trustees, said FACCT decided last year to cease its operations by the end of 2003. Lansky will assist in the wrap up of the organization’s operations by the end of this year. “FACCT was created in 1995 to fill a particular niche at a particular time,” Lansky wrote in a Sept. 23 letter announcing his resignation. “Increasingly, we have seen that the next key opportunity will lie in providing information directly to individual Americans – a job that is well beyond our scope or original design. While a great deal remains to be done to advance our ideas for a transformed health care system, we concluded that FACCT was not the best vehicle to continue that work.” For more info, www.facct.org. Back to top GAO Testimony Available Online The Government Accountability Office released testimony Sept. 21 on Medicare preventive services, “Most Beneficiaries Receive Some but Not All Recommended Services” Janet Heinrich, director, health care-public health issues, testified before the Subcommittee on Health, House Committee on Energy and Commerce Medicare Preventive Services. For more info, http://www.gao.gov/cgi-bin/getrpt?GAO-04-1004T. Back to top

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