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Most Seniors Still Not Using Web E-Health Groups Offer Recommendations for National System Study: Hospital Consolidation Does Not Improve Quality Surgeons Give NY Heart Care Reporting Bad Marks Guidelines Target Consumer Confusion About Quality Measurement Colon Cancer: Screening Underused and Often Misused New Guide to Implementing Evidence-Based Wellness Programs IHI Releases Video Series on Quality Of Care Grants Awarded For Innovative Patient Safety Research Dual Eligibles Risk Losing Drug Coverage During Transition to Medicare Briefing on Hospital Patient Safety Culture Survey New AHRQ Diabetes Care State Resource Guide A Kaiser Family Foundation survey shows that less than a third (31%) of seniors (age 65 and older) have ever gone online, but that more than two-thirds (70%) of the next generation of seniors (50-64 year-olds) have done so. As the Internet becomes an increasingly important resource for informing decisions about health and health care options, the survey points out that the differences among seniors and 50-64 year-olds are striking and indicates that online resources for health information may soon play a much larger role among older Americans. Twenty-one percent of seniors have gone online to look for health information compared to 53% of 50-64 year-olds; 8% of seniors get “a lot” of health information online compared to 24% of 50-64 year-olds. “We know that the Internet can be a great health tool for seniors, but the majority are lower-income, less well educated and not online,” said Drew Altman, President and CEO, Kaiser Family Foundation. “It's time for a national discussion on how to get seniors online.” The survey also finds that prescription drugs top the list of health care topics researched on line; that among those older Americans who have gone online for health information, a third (34%; 7% of all seniors) say they have talked with a doctor or other provider about information they found online and 23% (5% of all seniors) say they changed their own behavior because of information they found online; and that just 3% of 50-64 year-olds and 1% of seniors say a doctor has ever recommended a particular health or medical Web site to them. Copies of the report (#7223) are available on the Kaiser Family Foundation's Web site at www.kff.org. A group of 13 health and information technology organizations has given the Bush administration its recommendations for guiding development of a national health information network. The group called for open, nonproprietary technical standards for communication across the network. “The issue we tried to address is how do we mobilize America's incredibly fragmented health system to really get this done,” said David Lansky, a director of the health program at the Markle Foundation, which coordinated the work of the organizations involved, including the eHealth Initiative, American Health Information Management Association, the Healthcare Information and Management Systems Society and the Liberty Alliance Project. The group’s proposed “common framework” borrows heavily from the technical and policy approach of the Internet. The federal government, the report says, should guide the development of a health network by providing some initial financing and endorsing basic technical standards, but should set up a separate “standards and policy entity” to handle the task. The group recommended having the health network operate like e-mail, in which people using different types of computers and software can send and receive messages because the open, standard technology for handling messages is used by everyone. The report concluded that a national health network should not include a central database of patient records nor should it require individuals to have “health ID cards,” as some have proposed. It said that patients should control their own records, deciding whether their information can be used in studies for effectiveness of certain treatments and drugs. The study was delivered to the Bush administration's national health information technology coordinator, Dr. David J. Brailer, who had asked for recommendations on how to build a national health information network. The full study is available at: http://www.ehealthinitiative.org/assets/documents/ONCHITFull_document.pdf. A study published in the January-February edition of Health Affairs uses a range of data to show how joining a system changes hospital behavior. It finds that h ospital consolidation has served primarily to increase hospitals’ market power, not improve quality of care or hospital efficiency. Alison Evans Cuellar, an assistant professor in the Department of Health Policy and Management, Mailman School of Public Health, Columbia University , was the lead author of the study, "How the Expansion of Hospital Systems Has Affected Consumers.” The study said consumers were generally worse off as a result of hospital consolidation. In the area of efficiency, the study said that hospitals that joined systems did not do better than non-system hospitals. The study found that joining a system tended to raise spending per admission, but that did not necessarily translate into higher-quality care. For managed care patients, quality improved slightly on one measure: reduction in the rate of overused procedures. However, rates of avoidable inpatient mortality and inadequate patient safety did not change. Among fee for service patients, the study found no change in quality. According to the study, 51 percent of private, acute care hospitals were part of hospital systems in 1995 and this proportion rose to 57 percent by 2000. M ore information: www.healthaffairs.org. A recent study released shows that an overwhelming majority of cardiologists in New York may avoid operating on patients who might benefit from heart surgery because of concerns over hurting their public ratings. Sponsored by the University of Rochester , the survey of cardiologists reveals lasting objections that many doctors have with the public disclosure of their performance data. Eighty-three percent of the cardiologists surveyed said that because New York reports the mortality rates of heart surgeons, patients who might benefit from coronary angioplasty may not receive the procedure. In addition, 79 percent of the doctors said that the knowledge that mortality statistics would be made public had, at times, influenced their decision on whether to operate. According to the survey, about 75 percent of doctors said that the reports did not serve to improve patient care in the state, contending that public reporting of mortality data is not a fair measure of quality. For more: The New York Times, January 11, 2005. The Consumer-Purchaser Disclosure Project has issued a set of guidelines aimed at promoting a uniform approach to measuring the quality of hospital and physician performance. The guidelines urge organizations providing ratings of health care quality to use National Quality Forum-endorsed measures, or measures approved by federal agencies or national accrediting bodies; coordinate data collection with others measuring quality to minimize the burden to providers; publicly disclose the rating method used; and regularly review quality measures to reflect scientific advances. The Consumer-Purchaser Disclosure Project represents employer, consumer, and labor organizations working toward a common goal to ensure that all Americans have access to publicly reported health care performance information by January 1, 2007 . The project is supported by a grant from the Robert Wood Johnson Foundation and the Leapfrog Group, and has often been actively engaged in the National Quality Forum decision-making process. For more information: http://healthcaredisclosure.org/ Two recent studies show that effective colon cancer screening procedures are often not used by physicians or patients. The first study, an analysis of data from a large U.S. cancer registry, finds that more than half of older adults with colorectal cancer had a disease-detecting procedure within 6 months of their diagnosis—making it likely that the procedure was performed not as part of routine screening, but as a diagnostic test spurred by colon cancer symptoms. Forty-four percent of the nearly 6,000 patients had a test -- such as fecal occult blood testing (FOBT) or colonoscopy -- more than 6 months before their cancer diagnosis. In these cases, the procedures were probably done as part of colon cancer screening, said study co-author Dr. Gregory S. Cooper. Cooper, a gastroenterologist at Case Western Reserve University and the University Hospitals of Cleveland , published his findings in the February 15, 2005 issue of the journal Cancer. Cooper's team found that the 44 percent of patients who were most likely to have gotten tests for screening purposes were less likely to be diagnosed with colon cancer at a more-advanced stage. A second recent study found that a common screening test failed to detect potentially cancerous colon growths 95 percent of the time, falsely reassuring patients and doctors. Researchers found that the digital, in-office test on stool samples was not as reliable as a six-sample test given to patients to do on their own at home. The digital fecal occult blood test was positive in only 5 percent of patients with tumors or large, precancerous growths called polyps; the take-home test found 24 percent. “What we found is that it was pretty worthless,” Dr. David Lieberman, one of the study's authors, said of the in-office test. “It's a wake-up call that we shouldn’t be relying on this test.” The study, published this week in the Annals of Internal Medicine, was conducted at 13 Veterans Affairs medical centers and involved 2,665 patients who were given the at-home test and the in-office test followed by a colonoscopy. The survey, funded by the National Cancer Institute and the Centers for Disease Control and Prevention said one possible reason for using the office tests was concern that patients won't complete the home tests. The completion rate varies greatly, with the median between 40 and 50 percent. The National Business Group on Health has issued a guide designed to help employers implement successful disease prevention programs. Based on recommendations from the U.S. Preventive Services Task Force, the guide includes tools to help employers assess their employees’ health risks, choose appropriate preventive services, secure employee participation and evaluate program effectiveness. With preventable conditions such as cardiovascular disease and diabetes driving a growing share of the nation’s spending on health care, NBGH President Helen Darling said such preventive services and programs could save employers several times what they cost. The guide is available at: http://www.businessgrouphealth.org/services/4_Part_Guide.pdf. The Institute for Healthcare Improvement (IHI) has announced release of Pursuing Perfection in Health Care, a seven-part video series designed to help provider organizations raise the bar for health care performance. The series draws on the experiences of seven major health care institutions participating in the Pursuing Perfection initiative, a program supported by The Robert Wood Johnson Foundation under the technical direction of IHI. The series was produced by Crosskeys Media and serves as a basis for the forthcoming PBS series Remaking American Medicine by the same producers. Each video features a story spotlighting major quality issues in today’s health care system and includes a customized discussion guides that provide essential resources and directs the users to Web-based, ancillary materials designed to assist organizations in improving quality of care. “These videos offer a unique orientation to hard won lessons learned by veterans of clinical quality improvement,” AHQA executive vice president David Schulke wrote in a letter to IHI Don Berwick endorsing the series. “As an eye-opener and a call to action, this is a series that every clinical and administrative leader in every medical institution ought to see.” The seven-part series is available for $499, plus shipping and handling. For additional information: www.ihi.org The National Patient Safety Foundation (NPSF) has announced two grants for research projects that highlight patient safety initiatives in occupational therapy and community-based patient education. The NPSF Research Program joins with the American Medical Association (AMA) to support the grant, “Improve Patients’ Safety: Learning Model to Reduce Errors in Occupational Therapy and Physical Therapy Practice.” The $99,705 grant award is for a study aimed at understanding the phenomenon of practice errors in occupational and physical therapy, exploring preventive strategies, developing a learning model and disseminating educational materials designed to improve patient safety. NPSF’s second grantee is a team from the University of Cincinnati Department of Family Medicine. This team has been awarded $99,878 for a study that will investigate a community-based, patient safety intervention for independent living elderly. For more information: www.npsf.org. Dual Eligibles Risk Losing Drug Coverage During Transition to Medicare The danger of losing coverage during the transition may occur if there is a failure to choose a prescription drug plan, according to the study, The Medicare Low-Income Drug Subsidy: Strategies to Maximize Participation. The Medicare Rights Center recommended that CMS require drug plans serving the new Medicare drug benefit to offer open formularies or to honor Medicaid program formularies for six months to a year. The report is at: www.medicarerights.org/lowincomeissuebriefframeset.html. The Agency for Healthcare Research and Quality (AHRQ) in partnership with Premier, Inc., the Department of Defense, and the American Hospital Association, will host a free technical assistance telephone briefing on February 15, from 2:00 p.m. to 3:30 p.m. , EST, to discuss AHRQ's Hospital Survey on Patient Safety Culture survey tool. The purpose of the call is to arm those interested in adopting this tool with tips and techniques for administering the survey. The call will include the faculty responsible for the development of the survey and feature the experiences of users who have successfully adopted and implemented the survey. To participate, call 1-877-918-3008 and use 8310257 as the pass code. To guarantee a line on the call, please dial in by 1:45 p.m. , EST. Callers will be placed on a listen-only status during the event, followed by an interval for questions. The survey is currently available at http://www.ahrq.gov/qual/hospculture/. AHRQ, in partnership with the Council of State Governments, has released Diabetes Care Quality Improvement: A Resource Guide for State Action and a companion workbook, both designed to help states assess the quality of diabetes care and develop quality improvement strategies. The guide and workbook provide an overview of the factors that affect quality of care for diabetes, present the core elements of health care quality improvement, assist state policymakers in using the data from AHRQ's 2003 National Healthcare Quality Report for planning state-level quality improvement activities, and provide a variety of best practices and policy approaches that national organizations, the federal government, and states have implemented related to diabetes quality improvement. The guide is available at: http://www.ahrq.gov/qual/diabqualoc.htm.  Home :: Inside AHQA :: For The Media :: Public Policy :: Advancing Quality :: Quality Connections :: SiteMap
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