Quality Update for November 19, 2004

55% Surveyed Unsatisfied With Health Quality NQF to Hold Workshop on Standardizing P4P Principles Leapfrog Finds Variation in Patient Safety Practices New Report Looks at CAH Patient Safety NCQA to Continue HEDIS Work Diabetes Cost $133.5 Billion in 1990s Among Older Americans JAMA Editorial Calls for Workforce Leading HIT Implementation HIT Summit West Holding Call for Speakers AMIA Announces Call for Participants VA Center Develops ‘Falls Tookit’ 55% Surveyed Unsatisfied With Health Quality A consumer survey on medical errors found that one in three people continue to report experiencing medical errors either personally or in their family, with a significantly higher share of patients with chronic conditions reporting problems. While family and friend referrals remained the most common choice of information in selecting a provider, the report also showed an increasing use of quality data, and it indicated that patients have taken precautions to reduce the risk of medical errors. More than half of those surveyed (55%) said they are dissatisfied with the quality of health care, an increase from 44% who had the same response four years ago. The survey also finds that people with chronic health conditions are considerably more likely than other consumers to express concerns about their quality of care and report having personal experiences with medical errors (50% of those surveyed with chronic conditions compared to 30% without). The survey—a joint effort by the Kaiser Family Foundation, the Agency for Healthcare Research and Quality and the Harvard School of Public Health—is the third installment of data collection and primarily compares data between 2000 and 2004, to compare consumer perceptions since the release of the Institute of Medicine report, “To Err is Human: Building a Safer Health System.” Mollyann Brodie, vice president and director of public opinion and media research for Kaiser, explained that researchers conducted a random telephone survey 2,012 adults by telephone from July 7 to Sept. 5. 2004. Other findings include: 40% feel the quality of health care has worsened in the past five years; 34% say that they or a family member had experienced a medical error at some point in their life; 21% who experienced a medical error say it caused “serious health consequences” such as death (8%), long-term disability (11%) or severe pain (16%); 14% (3% of all Americans) of those with a serious health consequences say that they or their family filed a malpractice lawsuit. Of those who were involved in a medical error: 28% (9% of all Americans) say the doctor or other health professional involved told them about the medical error; 92% say that reporting of serious medical errors should be required, and 63% want this information released publicly. For more info, http://www.kff.org/kaiserpolls/pomr111704pkg.cfm. Back to top NQF to Hold Workshop on Standardizing P4P Principles The National Quality Forum (NQF) announced it has agreed to hold a workshop to begin standardizing pay for performance program principles and guidelines. The Centers for Medicare & Medicaid Services requested the NQF hold the workshop, which is scheduled for early 2005 in Washington, DC . “It is highly likely that within a relatively short time, pay-for-performance programs will become the norm for health care reimbursement,” said Kenneth W. Kizer, MD, MPH , President and CEO of the NQF. “ NQF officials said the main question is how those programs will be designed, and stressed that the measures must be based on standardized measures of quality and agreed-upon principles and guidelines. In April 2003, the NQF endorsed an initial set of 39 voluntary consensus standards for hospital care quality. Data on 10 of those standards are currently being reported under a public-private collaboration known as the Hospital Quality Alliance. In December 2003, the NQF announced an initiative to identify voluntary consensus standards for measuring the quality of ambulatory care. This five-year project will result in endorsement of a set of voluntary consensus standards that can be used as the basis of performance measurement in pay-for-performance initiatives for individual physicians. In 2004, the NQF endorsed 15 nursing-related voluntary consensus standards that provide a framework for measuring the quality of nursing care, and endorsed a set of 21 voluntary consensus standards for quality of cardiac surgery. For more info, www.qualityforum.org. Back to top Leapfrog Finds Variation in Patient Safety Practices The Leapfrog Group released the results of the Leapfrog Hospital Quality and Safety Survey, a national rating system of hospital quality and safety. This year’s survey is the first to include measures that cover all 30 of the safety practices endorsed by the National Quality Forum. Survey data from more than 1,000 hospitals reveal significant new findings about the state of health care quality and safety in the nation’s hospitals. A considerable portion of the survey asks hospitals about their awareness, accountability, ability and action on 27 of the NQF practices. Many hospitals are taking steps to implement them. Findings from the survey include: Eight in 10 hospitals have implemented procedures to avoid wrong-site surgeries; Seven in 10 hospitals require a pharmacist to review all medication orders before medication is given to patients. However, many hospitals still have significant progress to make: Seven in 10 report they do not have an explicit protocol to ensure adequate nursing staff, or a policy to check with patients to make sure they understand the risks of their procedures; Six in 10 lack procedures for preventing malnutrition in patients; Five in ten report they do not have procedures in place to prevent pressure ulcers; and, Four in 10 hospitals lack policies requiring workers to wash their hands with disinfectant before and after seeing a patient. For more info, www.leapfroggroup.org. Back to top New Report Looks at CAH Patient Safety The Flex Monitoring Team, a group of rural health researchers from the Universities of Minnesota, North Carolina and Southern Maine, has issued a report describing the patient safety results from a national phone survey of 474 critical access hospital ( CAH) administrators conducted in early 2004. Survey respondents were asked about top patient safety priorities, familiarity with the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) National Patient Safety Goals and implementation of initiatives related to the goals, factors that limit or support their ability to implement patient safety interventions, and pharmacist staffing and computer software to improve medication safety. More than half of the CAH administrators cited medication safety as their top patient safety priority or initiative. About 25% indicated that initiatives to prevent patient falls or eliminate the use of restraints are their top priority, especially in skilled nursing facility and swing beds. Overall, 63% of the surveyed CAHs report being familiar with the JCAHO National Patient Safety Goals. The authors concluded that the findings provide encouraging evidence of CAH interest in patient safety, but should be interpreted cautiously, because of the significant number of CAHs that reported that financial resources, staff time, and technology are limiting factors in their ability to implement patient safety interventions. For more info, http://www.flexmonitoring.org/documents/BriefingPaper3_PatientSafety.pdf. Back to top NCQA to Continue HEDIS Work The National Committee for Quality Assurance announced that the Centers for Medicare & Medicaid Services has awarded it two contracts to continue work NCQA has been performing for the Medicare program. This work allows CMS to monitor and publicly report on Medicare Advantage (formerly Medicare +Choice) health plan quality using NCQA’s HEDIS measures Medicare Advantage plans contract with Medicare to provide both Part A (hospital) and Part B (physician) services to enrolled beneficiaries. Currently, 4.6 million Medicare beneficiaries are enrolled in managed care plans. The first award, Implementing the HEDIS Medicare Health Outcome Survey, is a 5-year, $4.2 million contract to continue managing the administration of the Medicare Health Outcomes Survey, a large-scale survey that measures and reports on the health outcomes of Medicare Advantage plan members. The second award, HEDIS in Medicare Managed Care, is a 1-year, $1 million agreement to continue NCQA’s collection of HEDIS performance measures from Medicare Advantage plans, and to develop new performance indicators. For more info, www.ncqa.org. Back to top Diabetes Cost $133.5 Billion in 1990s Among Older Americans A University of Michigan study showed that diabetes care for Americans cost the country nearly $133.5 billion by the year 2000. “Diabetes has a staggering economic impact as well as serious health effects,” said Sandeep Vijan, an assistant professor of internal medicine and lead author of the study, which was funded in part by the Michigan Retirement Research Center at the university’s Institute for Social Research (ISR). The University of Michigan said about 18.2 million Americans are estimated to have diabetes, and given the aging of the population and the dramatic increase in obesity and sedentary lifestyles even among the young, the prevalence of diabetes is increasing at an epidemic rate. The Centers for Disease Control and Prevention in Atlanta recently estimated that given current trends, one in three people born today will develop the disease. For the study, published in the December issue of Health Services Research, Vijan and co-authors Rodney Hayward and Kenneth Langa analyzed diabetes-associated mortality, disability, early retirement and work absenteeism among a national household sample of older adults interviewed over an eight-year period. The average person with diabetes lost $2,800 in wages due to early retirement, $630 due to sick days, and $22,100 due to disability, the researchers concluded. When these results were projected to all diabetics born between 1931 and 1941—2.3 million people—the economic losses climbed to $58.6 billion. The study also found $60 billion in lost productivity prior to 1992 in the same age group, suggesting a total productivity loss due to diabetes of nearly $120 billion for the eight-year period analyzed. The analysis excluded people who were already disabled by diabetes at the start of the study. When the lost productivity of this group was added, the economic toll of the disease mounted to $133.5 billion. Since the analysis was limited to Americans born between 1931 and 1941, the total cost of productivity lost as a result of diabetes is much greater, the researchers said. For more info, www.med.umich.edu. Back to top JAMA Editorial Calls for Workforce Leading HIT Implementation An editorial in the Journal of the American Medical Association argues that even if all the commonly identified barriers to health information technology are resolved, a workforce must be developed to lead HIT implementation. Dr. William Hersh, of the Oregon Health & Science University School of Medicine’s Department of Medical Informatics & Clinical Epidemiology, in a Nov. 10 JAMA editorial, identifies the major barriers to HIT implementation as the financial costs, data interoperability and privacy concerns. He then adds that, even if the financial and technical issues surrounding the use of HIT are solved, a workforce capable of leading its implementation must be developed. “Physician informatics leaders must guide the effort in concert with others in health care, with appropriate knowledge and skill in informatics to lead efforts in all health care settings. These individuals need not necessarily be full-time informaticians or require extensive training, but they must understand the worlds of both medicine and IT,” he writes. Hersh said the process must also include other professionals such as health information managers, health science librarians, and representatives from other fields to assist in this process. http://jama.ama-assn.org. Back to top HIT Summit West Holding Call for Speakers Health Information Technology Summit West, a forum on electronic health records and information technology policy has issued a call for speakers for a conference scheduled for March 6-8, 2005 in San Francisco. Proposals may be submitted online at: www.ehcca.com/proposals/presentations.php?id_form=7. CD-ROMs of that conference held in Washington D.C. last month are now available. For more info, www.hitsummit.com. Back to top AMIA Announces Call for Participants The American Medical Informatics Association announced its call for participation for the AMIA 2005 Annual Symposium: “Biomedical and Health Informatics: From Foundations to Applications to Policy”. Details are available at: www.amia.org/meetings/annual/current. The submission site will be open on Jan. 12, 2005 and the submission deadline is March 16. Contributions will be accepted in two tracks: Foundations of Informatics, and Applications of Informatics. The foundations track will emphasize conceptual advances relating to the structure, processing, management and use of biomedical information. The applications track emphasizes innovations in the design, technology, implementation, use and evaluation of information systems and knowledge resources across the full spectrum of health care – in acute, ambulatory, and chronic care settings, public health departments, libraries, educational centers, and homes. Individuals may submit papers, posters, panels, demonstrations, and workshops for consideration by the Scientific Program Committee, chaired by Charles P. Friedman.  The AMIA Annual Symposium will be held in Washington, DC, Oct. 22-26. Back to top VA Center Develops ‘Falls Tookit’ VA National Center for Patient Safety (NCPS) has developed a guide to fall prevention and related injury reduction. The “Falls Tookit” is designed to provide comprehensive and practical resources for the prevention of falls and fall-related injuries. For more info, www.patientsafety.gov/fallstoolkit/index.html. Back to top

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