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Study: Increased Competition in Health Care
May Not Increase Quality
Cultural Competence Fellowships Available
How
to Run “Virtual” BTS Collaboratives
Study: Surgical Infection Risk Declines after
Age 65
Program To Help Patients Find Discount Drug
Programs
Report Examines New Diabetes Management Devices
Alzheimer’s
Association Releases Recommendations on Dementia Care
NQF Plans Meetings in St. Louis
AHRQ Launches New Online Clearinghouse: Patient
Safety Network
CMS
Holds ‘Special Open Door Forum’ on
MMA Demonstration Project
CMS Holds Summit on Hospital QI and Public
Reporting
Final
AHRQ Briefing on Hospital Survey: Experts Available for Q&A
Study:
Increased Competition in Health Care May Not Increase Quality
Results of a study published in the April edition of Medical Care indicate
that increasing competition in health care may not lead
to better quality.
Using data
from 341 HMOs operating in various markets across the nation, researchers
analyzed enrollment and the most widely used measures of HMO performance:
the Health Plan Employer Data and Information Set (HEDIS), which measures
the percentage of a health plan's eligible population that is compliant
with recommended care guidelines and the Consumer Assessment of Health
Plans Survey (CAHPS), which assesses plan participants’ opinions
about their health care, physicians, and services their plan provides.
The researchers
found that HMOs in less competitive markets scored higher on HEDIS’ women’s
care measures and the CAHPS factors. No difference was found in performance
on childhood or adolescent immunization or the management of chronic
illness. Overall, HMO performance was better in markets with a greater
percentage of HMO enrollment. Performance in for-profit and non-profit
plans was similar.
The researchers also found that for HMOs that chose to make their data
available publicly, which is not required, performance significantly
improved on both HEDIS and CAHPS measures.
“Our findings show that less, not more, competition was associated
with better health plan performance in several -- though not all--factors,” says
lead author Dennis Scanlon, associate professor of health policy administration
at Penn State . “This finding seems counterintuitive, but it is
possible that more HMO competition may result in providers finding it
difficult to respond to competing quality initiatives. Also, competition
may be focused more on driving down the plans’ premiums, resulting
in less attention to quality.”
To read
the abstract, go to: http://www.lww-medicalcare.com
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Cultural Competence Fellowships Available
Applications
for a new Cultural Competence Leadership Fellowship are being accepted
by the Health Research & Educational Trust (HRET—an
AHA affiliate) through the end of April. This professional development
program, designed to develop leaders in health care who are more culturally
competent, is the result of cooperation between the Institute for Diversity
in Health Management, Health Forum, and National Center for Healthcare
Leadership.
In 2001, the Institute of Medicine's Crossing the Quality Chasm reported
a critical gap in the quality of treatment for patients from racial and
ethnic minority groups. The Cultural Competence Leadership Fellowship
is designed to address this issue by helping health care deliver equitable
care. Graduates of this self-directed 14 month course will gain knowledge
that can be used within their organizations to narrow the health disparity
gap and promote effective, high quality health care for racial and ethnic
minorities.
For more information and an application, visit http://www.hret.org/hret/about/cclf.html
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How
to Run “Virtual” BTS Collaboratives
IHI is
presenting an all-day, web-based course to teach QIOs and others how
to run Breakthrough Series Collaboratives on the Web—as a 21
st century alternative to face-to-face learning sessions. Called “The
Virtual Frontier,” the course will run on April 28 from 11:00 am
to 5:00 pm ET .
This webinar is designed for those already trained or experienced in
running face-to-face Breakthrough Series Collaboratives.
The program will provide the skills and tools necessary to adapt the
Breakthrough Series methodology to the web and will use web conferencing
technology to facilitate the day-long training. Participants will learn
how to:
- Design and run a Virtual Collaborative using web conferencing technology
- Build an engaged virtual community
- Train and engage faculty and participants in teaching in this environment
- Determine elements of a successful Virtual Learning Session
- Optimize the business model for a Virtual Collaborative
More
information
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Study: Surgical Infection Risk Declines after
Age 65
Duke University researchers, in one of the largest studies to date
of surgical site infections (SSI) in adults, found that SSI risk increases
each year of age until a patient reaches 65, when the risk begins to
drop. Their findings are published in the April issue of The Journal
of Infectious Diseases.
The study included nearly 145,000 patients who underwent surgery at
11 hospitals in the Duke Infection Control Outreach Network between February
1991 and July 2002. Of that patient sample, 1,684 surgical site infections
were identified, representing a rate of 1.2 percent, which is comparable
to the national average. All SSIs were identified by infection-control
practitioners using standardized Centers for Disease Control and Prevention
criteria for nosocomial infections.
Researchers found that the risk of SSI increased linearly by 1.1 percent
per year in patients aged 17 to 65, but decreased linearly by 1.2 percent
per year for patients 65 years and older. No infections were reported
in patients more than 95 years old.
The study
comes to no conclusions about why the risk of SSI declines after age
65. But lead author Keith Kaye, M.D., assistant professor of infectious
diseases at Duke University Medical Center says, “If
elders are at a decreased risk due to a surgical selection bias -- in
which only healthier elders are selected for surgery -- this is important
to know and to address. Maybe age shouldn't be weighted heavily in surgical
selection issues. Alternatively, if the decreased risk is associated
with an innate immune phenomenon, it would be important to understand
this process and its implications for other types of infections.” For
more information: becky.oskin@duke.edu
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Program To Help Patients Find Discount Drug
Programs
The Pharmaceutical Research and Manufacturers of America (PhRMA) is
spearheading an effort by leading pharmaceutical companies to direct
patients to discount prescription drug programs.
The project, called Partnership for Prescription Assistance was launched
nationwide on April 5. It includes a toll-free number and website where
those qualifying for assistance can receive help navigating the 150 discount
programs operated by manufacturers and 125 plans run by governments and
private groups.
Each program has different criteria for qualifying. Some are for individuals
with annual incomes of less than $19,000 or families of three with incomes
of less than $31,000. About 29 million people in the U.S. meet those
income requirements and lack drug coverage, the manufacturers group said.
The project
is part of a series of initiatives planned by the pharmaceutical industry
to provide lower cost drugs for those in need—in the face
of growing pressure for government regulation of drug pricing or for
importation of drugs.
The Medicare prescription drug program, scheduled to begin in January
of 2006, may possibly lower demand for some discounts. However, the referral
service is expected to help those low income Americans without health
insurance find lower priced medications.
Companies
participating in the program include Abbott Laboratories, Bristol-Myers
Squibb Co., Johnson & Johnson, Merck & Co., Pfizer
Inc. and AstraZeneca PLC. It is estimated that the companies will spend
tens of millions of dollars to advertise Partnership for Prescription
Assistance.
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Report
Examines New Diabetes Management Devices
The New
England Healthcare Institute issued a report in March discussing the
development of electronic devices for continuous glucose monitoring
(CGMs) that could revolutionize diabetes management and vastly improve
quality of care within the next five years.
The report, “Continuous Glucose Monitoring: Innovation in the
Management of Diabetes,” says that to fully maximize the potential
benefits, the devices will require integration into physician practice
patterns and information technology systems.
A first generation of these monitoring systems is already on the market,
but currently has Food and Drug Administration approval only for use
with the standard finger-stick method of drawing blood samples. The report
says that in three to five years a second generation of continuous glucose
monitors may pass FDA scrutiny, achieve payer acceptance and be in widespread
use.
The new
devices, according to the report, “have the potential
to be highly valuable and cost-effective tools in managing diabetes,
particularly for long-term, daily management.” They will share
a common set of features that will make them popular as well as clinically
effective, such as:
- Automatic readings, ranging from every 5 to 20 minutes.
- Sufficient accuracy so patients can make changes themselves to their
disease-management routines.
- Alarms to warn patients when their blood glucose levels are trending
high or low.
- Access to decision-support tools to advise patients on a proper
course of action, including proper insulin dosage levels.
Studies
show that tightly monitored glucose levels greatly improve health and
reduce mortality for diabetic patients. But, according to the American
Diabetes Association, only 37 percent of diabetic patients nationally
are achieving recommended levels of glucose control. The new devices
could improve quality of care by closely monitoring glucose levels
and “by providing a measure of freedom from blood glucose monitoring
kits and minimizing disruption to daily activities,” the report
says.
The report also identifies several potential barriers to development
and widespread adoption of CGMs including: obtaining FDA agreement that
CGMs are a sufficient replacement for episodic monitoring, broad-scale
payer coverage of CGMs as outpatient devices, adoption by clinicians
and integration into their practice patterns, and patient education and
acceptance. Next steps recommended by the report include coordinated
efforts by various stakeholders to address each barrier.
A summary of the report is available at: http://www.nehi.net/CMS/viewPage.cfm?pageId=29
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Alzheimer’s
Association Releases Recommendations on Dementia Care
With the
goal of helping raise the quality of care for individuals with dementia
who live in nursing homes and assisted living facilities nationwide,
the Alzheimer’s Association released the Dementia
Care Practice Recommendationsfor Assisted Living Residences
and Nursing Homes on March 29.
The result of collaboration among 24 leading organizations representing
residential care providers, professionals, care staff, and consumers,
the recommendations were developed based on research.
The recommendations
represent a person-centered approach to care that involves using awareness
of the resident’s abilities, personal
history and preferences to provide individualized care. Over the next
several years, the Association and the collaborating organizations will
release a variety of more specific recommendations focusing on different
aspects of dementia care. This first year, the recommendations will focus
on food and fluid consumption, pain management, and social engagement.
“People with dementia present unique care challenges because
of communication barriers that are due to memory loss. As the population
ages, facilities will see a large increase in the number of people with
dementia, creating the need to better train staff to meet the needs of
these individuals,” said Kathleen O’Brien, senior vice president
of program and community services, Alzheimer’s Association. “The
time to act is now so that by the time baby boomers enter retirement,
good dementia care will already be the standard of care.”
For more information on the recommendations, contact: Pam Rwankole
at pam.rwankole@alz.org, or
call 312-335-5719 or 800-272-3900.
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NQF Plans Meetings in St. Louis
The National Quality Forum will hold a series of meetings in St. Louis
, May 9-11.
On May 9, attendees of the CMS -NQF Implementation Conference will
be able to engage with CMS on issues related to national quality improvement
efforts and implementation of NQF measures, network with colleagues,
and collaborate on shared strategies for quality measurement and reporting.
NQF members
will hold their spring membership meeting on May 10, which will include
plenary and break out sessions as well as members-only briefings on
NQF’s activities. The NQF board meeting, which is open to the
public, will be held May 11 (advance registration is required).
For more information, contact the NQF at http://www.qualityforum.org/.
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AHRQ Launches New Online Clearinghouse: Patient
Safety Network
On April 12, the Agency for Healthcare Research and Quality unveiled
the Patient Safety Network, or PSNet, an online clearinghouse for resources
on improving patient safety and preventing medical errors.
According
to the website, PSNet offers a “continuously updated,
annotated, and carefully selected collection of patient safety news,
literature, tools, and resources.” It also offers a customization
feature that automatically collects the latest articles, news, and conferences
on topics of interest for individual users. Weekly updates on the latest
patient safety findings are also available.
AHRQ Director
Carolyn Clancy, M.D., says the site, which is intended for use by hospital
administrators, clinicians, researchers, and consumers, is a “one-stop
portal for patient safety resources to help health care professionals
improve health care for all Americans.”
Visit the Patient Safety Network at: http://psnet.ahrq.gov/
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CMS
Holds ‘Special Open Door Forum’ on
MMA Demonstration Project
On Wednesday,
April 20, from 2-4 PM , the Centers for Medicare & Medicaid
Services (CMS) will hold a “Special Open Door Forum” teleconference
to obtain public comment on Section 646 of the Medicare Modernization
Act: Medicare Health Care Quality Demonstration Project.
Access
the call by dialing: 1-800-837-1935 & Reference Conference
ID # 5243929; no RSVP is necessary. Questions for the conference call
can be submitted in advance to mma646@cms.hhs.gov and
will be reviewed for possible inclusion during the discussion.
CMS policy staff from the Office of Research, Development and Information
will be on the call to discuss design of the demonstration project, which
focuses on the delivery of improved quality of patient care and increased
efficiency. The project was mandated in Section 646 of the MMA .
Factors
to be studied include: incentives to improve health care safety, quality,
and efficiency; use of best practice guidelines; examination of variations
in utilization and outcomes measurement and research; shared decision
making between providers and patients; and culturally and ethnically
sensitive health care delivery.
CMS intends to use the demonstration project to identify, develop,
test, and disseminate major multi-faceted improvements to the entire
health care system. The Agency for Healthcare Research and Quality (AHRQ)
may also use this program as a laboratory for the study of quality improvement
strategies.
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CMS Holds Summit on Hospital QI and Public
Reporting
On May
25 th, the Centers for Medicare & Medicaid Services ( CMS
) and the Delmarva Foundation will sponsor the CMS Summit on Hospital
QI and Public Reporting at the
Ronald Reagan International Trade Center in Washington , DC . The one
day event will bring together experts in quality improvement, public
health, and health care systems.
Sessions offered at this conference will include discussion of hospital
leadership and QI survey results; hospital leadership response to publicly
reported information; state and business coalition quality reports; and
implications for hospitals and reporting programs. Stephen Jencks, MD,
MPH , Director, Quality Improvement Coordination, OCSQ at CMS will wrap
up the day with a discussion of lessons learned and future prospects.
For more information, contact Roxanne Rodgers at rrodger@dfmc.org or
800-999-3362 or Anna Shearer, MPH at shearer@jcaho.org or
630-792-5955.
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Final
AHRQ Briefing on Hospital Survey: Experts Available for Q&A
The Agency for Healthcare Research and Quality will hold its final
technical assistance briefing on the Hospital Survey on Patient Safety
Culture on April 22, from 2 to 3:30 PM EST.
The briefing, “Taking Action,” will
address how to communicate survey results within hospitals, and how
to prioritize and plan actions. It will also address accountability
for change. The call will include a 30-minute question-and-answer session
for experts in survey action planning and hospital quality initiatives
to answer participant inquiries.
The call is free, but participants should register by sending their
first name and last name in the body of an e-mail to safetyculturesurvey@westat.com.
The call-in number, pass code, and materials will be sent by email prior
to the call.
The Hospital Survey on Patient Safety Culture is online at: http://www.ahrq.gov/qual/hospculture/
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