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NQF
Launches Pay For Performance Project Major Insurer Boosts National Patient Safety
Foundation Initiative NIH Action Plan on Liver Disease Research VA Scores Better on Certain Preventive, Chronic
Care Measures, Study Finds CDC Expands Priority Groups for Flu Vaccination AHRQ Offers New Guides and Tools for Diabetes
Care Computerized Medication Systems Not Foolproof,
USP finds New Study on Pain Reporting by Nursing Home
Residents Quality
Data Not Part of CMS Requirements For Managed Care Transition Medicare Begins Covering New Preventive Health
Benefits The National
Quality Forum has announced a new project: “Pay-for-Performance
Programs: Guiding Principles” that will assess health care initiatives
in which payment is used to promote higher quality care. The NQF will hold a conference March 1-2, 2005 in Washington, DC to
review the array of pay-for-performance initiatives currently underway
across the country and to determine what lessons can be learned from
these efforts, with an eye towards identifying a common set of principles
for designing and implementing pay-for-performance programs. The project will also review pay-for-performance initiatives that have
not succeeded and identify current gaps in knowledge regarding pay-for-performance.
The conference will be open will be open to NQF Members and the general
public. For more information: www.qualityforum.org. The National
Patient Safety Foundation (NPSF) announced that AIG Healthcare, a division
of the property-casualty insurance subsidiary of American International
Group, Inc. ( AIG ), has joined NPSF’s Stand
Up for Patient Safety ® initiative. Through this collaboration,
AIG Healthcare will support its client hospitals’ participation
in the Stand Up for Patient Safety program by applying a risk
management credit to applicable insurance premiums. Both NPSF and AIG
Healthcare expect the joint effort to have a positive effect on member
hospitals’ patient safety and risk management efforts. Nearly 200 member hospitals and health systems are participating in Stand
Up for Patient Safety, a national hospital-based program involving
use of educational tools and collaborative opportunities designed to
move patient safety and risk management initiatives forward. For more on the initiative and AIG participation: www.npsf.org. NPSF also
recently announced the launch of an interactive Web site containing
three education modules focused on physicians, nurses and patients. This
Web site was developed under a grant from the Agency for Healthcare
Research and Quality (AHRQ) to research and create a standard method
of patient education to reach large audiences. The physician’s module offers continuing medical education credits
( CME ); the nurse’s module offers continuing educational units
(CEUs). These educational units are offered through the Medical
College of Wisconsin. The patient
section of this educational Web site provides fundamental information
to achieve safer patient care. Topics include medication
safety, pediatric care, and medical device safety. There is also
a module specifically addressing anesthesia patient safety. For
more: www.npsf.org. The National Institutes of Health has released an action plan for U.S.
liver disease research. Research goals include improved therapies for
hepatitis C, standardized and objective diagnostic criteria for major
liver diseases, and ways to decrease liver disease mortality rates. Liver and gallbladder disease accounts for about 46,000 U.S. deaths
each year, affecting persons of all ages, but most frequently individuals
between the ages of 40 and 60 years old. Liver disease also disproportionately
affects minority individuals and the economically disadvantaged. The Action Plan for Liver Disease Research can be downloaded at http://www.niddk.nih.gov/fund/divisions/ddn/ldrb/ldrb_action_plan.htm. Patients
enrolled in the Department of Veterans Affairs health system were more
likely than similar patients in the general population to receive preventive
and chronic care recommended by established national guidelines, according
to a study in the Dec. 21 Annals of Internal Medicine.
The researchers used quality indicators from Rand Corp. to evaluate
inpatient and outpatient care for 26 conditions. The 348 indicators included
measures such as aspirin for patients presenting with acute myocardial
infarction, diet and exercise counseling for diabetes, and screening
for colorectal cancer.
Overall,
VA patients received 67% of the recommended care compared with
51% in the national sample; 72% of the indicated chronic care compared
with 59% in the national sample; and 64% of the indicated preventive
care compared with 44% in the national sample. The quality of care
for acute conditions was similar across both study populations.
The differences between the VA and national sample were greatest in
processes subject to the VA health system’s performance measurement
system. The
Centers for Disease Control and Prevention’s (CDC) Advisory
Committee on Immunization Practices (ACIP) has expanded the list of priority
groups recommended to receive inactivated influenza vaccine this flu
season, depending on the availability of influenza vaccine in state or
local health jurisdictions.
Effective
January 3rd, in locations where state and local health authorities
judge vaccine supply to be adequate to meet demand, the priority groups
for inactivated influenza vaccine will include adults age 50-64 and
out-of-home caregivers and household contacts of persons in high-risk
groups. People in the high-risk groups for serious complications from
influenza include persons aged 65 years or older, children aged less
than 2 years, pregnant women, and people of any age who have certain
underlying health conditions such as heart or lung disease, transplant
recipients, or persons with AIDS.
In
response to this season’s vaccine shortage, the ACIP previously
recommended inactivated influenza vaccine for all children aged 6–23
months, adults aged 65 years and older, persons aged 2–64 years
with underlying chronic medical conditions, all women who will be pregnant
during the influenza season, residents of nursing homes and long-term
care facilities, children aged 6 months–18 years on chronic aspirin
therapy, health-care workers involved in direct patient care, and out-of-home
caregivers and household contacts of children aged <6 months.
For more: http://www.cdc.gov/od/oc/media/pressrel/r041217.htm. The second
volume in the series of AHRQ Evidence-based Practice Center Technical Reviews,
titled Closing the Quality Gap: A Critical Analysis
of Quality Improvement Strategies, Volume 2: Diabetes Mellitus Care,
is now available.
The Quality
Gap EPC reports explore the human and organizational factors influencing
quality improvement strategies and evaluate nine quality improvement strategies,
tools, or processes aimed at reducing the quality gap. Volume 2 examines
strategies for improving the quality of care for adults with type 2 diabetes
through changes in provider behavior, patient behavior, and modifications
to the organization of care. Outpatient care for diabetes exemplifies the
challenges of, and opportunities for, chronic disease management. For more: http://www.ahrq.gov/clinic/qualgap2.
AHRQ has
also developed and recently made available new tools to help states improve
the quality of diabetes care. These materials, designed in partnership
with the Council of State Governments to help states assess the quality
of diabetes care and create quality improvement strategies are available
at http://www.ahrq.gov/qual/diabqualoc.htm. Computer
technologies used to order and dispense medications were involved in
nearly 20% of the hospital and health system medication errors reported
to U.S. Pharmacopeia’s national voluntary database last
year.
Computer entry
errors, in which incorrect or incomplete information was entered into a
computer system, accounted for more than 27,000 errors, with distractions
(56.5%), increased workloads (20.4%) and inexperienced staff (17.9%) cited
as contributing factors.
Computerized
Physician Order Entry was associated with more than 7,000 errors. However,
99% of errors associated with CPOE did not reach or harm patients,
suggesting the technology can reduce the risk of harmful errors, USP
concluded. Automated
dispensing devices, computer systems used to store and dispense drugs,
were implicated in almost 9,000 errors, most of them involving the
wrong dose or drug. USP
data also showed that the rate of computer entry prescribing errors
has steadily risen since 1999. In 2003, computer entry errors were
the fourth leading cause of medication errors in U.S. hospitals and
health systems, USP said. In its news
release, USP did not discuss the possibility that the automated systems
may facilitate error reporting and as a result comprise a disproportionate
share of reported errors. The
data come from USP's annual report summarizing the information
collected by MEDMARX, its national medication error reporting system.
The report, "MEDMARX
5th Anniversary Data Report: A Chartbook of 2003 Findings
and Trends 1999-2003," analyzes 235,159 medication
error records voluntarily reported by 570 hospitals and health
care facilities across the United States. For more: www.onlinepressroom.net/uspharm. In
a new study by the Borun Center for Gerontological Research, the
vast majority of nursing home residents, including half of those
with the most severe cognitive impairments, were able to answer four
simple, direct questions about their experience of pain. Study
investigators say their findings show that nurses and nurse aides can use
responses from the questions to identify residents with chronic pain, thereby
paving the way for improved management of a widespread clinical problem
that experts say too often is under-treated in nursing homes.
The
Borun Center is a joint venture between the UCLA School of Medicine
and the Jewish Home for the Aging of Greater Los Angeles. The
study is reported in the December issue of the Journal of the American
Geriatrics Society. The authors interviewed long-stay residents
in 33 nursing homes to determine how many could provide stable responses
to these four questions: “Do
you have pain now?” “Does pain keep you from sleeping at
night?” “Does your pain keep you from participating in activities?” “Do
you have pain every day?”
Based
on their findings, the researchers recommend that nurses and
nurse aides ask all communicative residents directly about pain using
the study’s four questions. Residents identified with chronic
pain should be further evaluated by a licensed nurse or physician to
assess the need for treatment. Non-communicative residents, such as those
in the final stages of Alzheimer’s disease, are best assessed
for pain using an observational tool. For more info: http://borun.medsch.ucla.edu.
Health plans that want to continue in Medicare managed care for 2006
will not have to submit information on their quality improvement (QI)
performance as part of the transition to the Medicare Advantage (MA)
program, CMS announced on December 23. Although
MA organizations are required to have a QI program and measure performance,
system interventions, and improvements, the plan's data on these will
not be required as part of the transition submissions, CMS said. The
plans will only have to sign an attestation that they meet QI requirements. The
policy on QI is contained in draft guidance geared for heads of health
plans that are transitioning from the Medicare+Choice program to the
MA program in 2006. The guidance is intended as an overview of the steps
that health plans must take to be compliant with the Medicare Prescription
Drug, Improvement, and Modernization Act of 2003. The changes affect
2006-related activities that occur in 2005. Comments on the draft guidance are due to CMS by Jan. 7, 2005 at http://www.cms.hhs.gov/healthplans/maapplications/default.asp.
On
January 1, Medicare began offering a new benefit: the Welcome to
Medicare Visit (WMV) that will include cholesterol and diabetes screening
tests. The Medicare Modernization Act ( MMA ) permits payment for
one initial preventive physical examination within the first 6 months
after the effective date of the beneficiary’s first Part B
coverage period, but only if that coverage period begins on or after
January 1, 2005. MA
defines an ‘‘initial preventive physical examination’’ to
mean physician and certain qualified non-physician practitioner services
consisting of all of the following:  Home :: Inside AHQA :: For The Media :: Public Policy :: Advancing Quality :: Quality Connections :: SiteMap
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