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Free Advance Directive Form Helps Low Literacy
Adults What Makes for Success in Health Care IT? Survey: Quality Not a Priority for Many CIOs CA Providers Collaborate to Create Health Information
Exchange Network Survey Finds Significant Expansion of P4P Nationwide National
Survey: Many Seniors Say They Don’t
Take Medications As Prescribed Why
Seniors Don’t Take Meds as Prescribed The Institute for Healthcare Advancement has released an advance directive
form designed to help low-literacy adults express their health care wishes.
Available online in both English and Spanish, the free form allows a
person to legally declare what should happen in the event of serious
illness or injury. Existing advance directives are difficult to understand for the estimated
90 million American adults read who below a fifth-grade level. The new
low-literacy document is designed in a simple fill-in-the-blank format
with illustrations and easy-to-read bullet points. It enables low-literacy
Americans to choose an agent to make medical decisions for them, make
their health care wishes known so that their loved ones don’t
have to guess as to their preference at times of high stress and possible
family discord, and provide the necessary signatures to make the document
legally binding. For more information, visit: http://www.iha4health.org/ Health care executives largely disagree over who should be responsible
for the governance and implementation of health IT systems, suggests
results of a survey based on 235 individual online responses in February
and Ma rch. Invitations
to complete the survey were sent to 14,000 individuals, executives
representing 4,000 hospitals and health care systems across the country.
Using a set of criteria established by HIMSS Analytics, the survey
identified 29 “successful organizations” among
the respondents, of which four were interviewed to develop case studies
of successful implementations. Ninety-one percent of the organizations surveyed said that the CIO
is managing the information systems department, but for the successful
organizations in the survey, this is not so. In those organizations,
the executive responsible for a specific business area (nursing, pharmacy,
surgery) is responsible for driving value from the IT investment. The
CIO and staff serve as facilitators to support these business areas. The survey
also revealed that only 16 percent of responding organizations believed
governance to be a critical component in the success of their IT programs.
However, governance was identified as a critical, high-priority issue in
the successful cases. The survey was underwritten by Lawson Software and conducted by the
Scottsdale Institute, a not-for-profit corporation that provides an information
management sharing ground for health care organizations, and HIMSS Analytics,
a wholly owned subsidiary of the Healthcare Information and Ma nagement
Systems Society. A survey of 80 hospital and health system chief information officers
(CIOs) provides insight into their role in quality and performance-improvement
initiatives. Only half of the CIOs surveyed are members of quality or
performance-improvement committees at their organizations, while one
in five CIOs provide no input at all on quality or performance activities. The survey, conducted by the College of Information Ma nagement Executives
and First Consulting Group, queried CIOs at individual hospitals and
in multi-facility health care enterprises. Reporting structure is seen by some CIOs as a barrier to addressing
quality and performance-improvement, with many CIOs reporting to the
CFO a holdover from when IT systems mostly handled financial operations.
With the addition of clinical systems, these respondents felt that it
would be more appropriate to report to the CEO. Health care organizations in California are collaborating on a health
data exchange network to ensure that all patients have electronic health
records. Organized
in response to the Bush administration’s national health
care technology initiative, the coalition is managed by the Health Technology
Center (HealthTech) with initial funding from the California HealthCare
Foundation. The California Regional Health Information Organization will
foster local, regional, and statewide projects that allow patient information
to be shared efficiently and securely by health care providers at the
point of care. To date, Sutter Health, Kaiser Permanente and the WellPoint Foundation
have contributed $1 million grants to the initiative, while John Muir/Mt.
Diablo Health System, Cedars-Sinai Health System and the University of
California also have contributed funding. Lumetra, the California QIO,
is a founding member and its CEO, Jo Ellen Ross, is a leader in the initiative. For more information: http://www.healthtech.org/. The Commission
to End Health Care Disparities recently released a survey indicating
that physicians are becoming more aware of health care disparities
and many are seeking out ways to address the issue in their own practices.
The national survey of nearly 2,000 physicians, conducted by the American
Medical Association ' s Institute for Ethics, is part of the commission’s
first comprehensive survey to measure physicians’ awareness and
actions regarding health care disparities. “There is a great deal of work to be done to end health care
disparities, but this survey is encouraging. It shows that physicians
of all races are eager to learn how they can do more to eliminate disparities
in medical care,” said AMA President John C. Nelson, MD, MPH. The survey found that 55 percent of physicians believe that minority
patients generally receive a lower quality of care than non-minority
patients. Seventy-five percent of physicians report that they are in
a good position to improve the quality of care that minority patients
receive and many physicians participate in quality improvement efforts.
Other findings include: “This survey strongly suggests that momentum among physicians
is growing strong to improve the health and health care of racial and
ethnic minority patients,’ said Randall W. Maxey, MD, PhD, Immediate
Past President of the National Medical Association and co-chair of the
commission. ‘The commission can now build on this momentum by providing
physicians with the tools and resources they need to make an impact on
health care disparities.’ To read
a brief of the survey, visit: http://www.ama-assn.org/ama/pub/category/14969.html Med-Vantage,
a San Francisco-based health information company, has released the
results of a survey indicating rapid growth in the number of provider
pay-for-performance programs across the country. The survey, “Provider
Pay-for-Performance Incentive Programs: 2004 National Study Results” queried
50 out of 84 P4P program sponsors across the country. In 2003, according to the survey, 39 P4P programs existed throughout
the nation. That number increased to 84 in 2004 and to 104 as of March
2005. Survey
respondents indicated several key trends, including significant expansion
of P4P programs in three major categories of organizations: preferred
provider organizations, consumer directed health care plans, and medical
specialists. Respondents also noted a growing interest in using P4P
results for public reporting and “the emergence of the
Centers for Medicare & Medicaid Services (CMS) as a P4P market driver.” The primary reason for implementing P4P programs is to improve clinical
outcomes and the biggest problem is concern about statistical and data
results when patient numbers are small, the survey respondents said.
Other key recommendations for new P4P program sponsors are early provider
involvement and use of generally accepted, standardized measures. Beau Carter,
co-author of the study and a senior health policy and strategy consultant
for Med-Vantage, said P4P programs are “moving
to more sophisticated designs that assess both the quality and efficiency
of specialist care and the critical use of information technology to
improve care coordination, patient compliance, and patient safety.” Visit: http://www.medvantageinc.com/Pdf/MV_2004_P4P_National_Study_Results-Exec_Summary.pdf to
read the executive summary of “Provider Pay-for-Performance Incentive
Programs: 2004 National Study Results.”
A national survey of nearly 18,000 seniors shows that four in 10 have
not taken their medication as prescribed by their physician in the past
year -- either because the costs were too high, because they thought
the drugs were not working, or because they did not think they needed
them. The survey, conducted by the Kaiser Family Foundation, the Commonwealth
Fund, and Tufts-New England Medical Center , was published in the April
19 edition of Health Affairs. The survey was conducted in 2003, prior to the enactment of the Medicare
Modernization Act, and included a representative national sample with
oversampling from 12 states - California, Colorado, Florida, Illinois,
Louisiana, Michigan, New York, Ohio, Pennsylvania, Texas, Tennessee and
Washington. Of the 89 percent of seniors who report taking prescription drugs in
the past year, nearly half take five or more, more than half have more
than one doctor who prescribes medicine, and about a third use more than
one pharmacy. Among seniors with at least three chronic health conditions,
73 percent take five or more medications regularly and more than half
do not take all their drugs as prescribed. “With two out of five seniors not taking medicines as prescribed,
there is a real opportunity to improve patient care both by urging doctors
and patients to talk more about these issues and by developing systems
to monitor quality and safety,” said Commonwealth Fund President
Karen Davis, Ph.D. “These steps are an important complement to
the new Medicare prescription drug coverage.” Nationally, 27 percent of seniors reported that they did not have any
prescription drug coverage at the time of the survey. Coverage rates
varied widely across states, with seniors in Louisiana and Washington
more than twice as likely to lack coverage than seniors in New York .
Among low-income seniors nationwide, one-third lacked coverage - and
in several states, including Ohio , Louisiana , Texas and Washington
, more than 40 percent of low-income seniors lacked coverage. Why
Seniors Don’t Take Meds as Prescribed Seniors cited their experiences with their medications as a reason
for not taking their medications as prescribed as almost often as they
cited the cost of their drugs, with 25 percent saying they skipped doses
or stopped taking a drug because it made them feel worse or was not helping,
and 26 percent saying that they did not fill a prescription, skipped
doses or took smaller doses due to cost reasons. Drug coverage made a substantial difference in adherence rates, with
37 percent of seniors without drug coverage reporting cost-related non-adherence,
compared with 22 percent of seniors with drug coverage. Low-income seniors
without drug coverage generally took fewer drugs than those with drug
coverage. “The substantial variations in drug coverage across states documented
in this survey suggest that targeted outreach efforts have the best chance
of reaching seniors,’ said Kaiser Family Foundation President Drew
E. Altman, Ph.D. Read the
article, “Prescription Drug Coverage and Seniors: Findings
from a 2003 National Survey,” at: http://www.kff.org/medicare/med041905pkg.cfm and www.cmwf.org  Home :: Inside AHQA :: For The Media :: Public Policy :: Advancing Quality :: Quality Connections :: SiteMap
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