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American Journal of Surgery: QIO National
Collaborative Cuts Surgical Infection Rates AHQA Contests JAMA Article on QIOs AHRQ Provides $8 Million in Grants for 15 Patient
Safety Projects AHRQ Publishes Clinician-Friendly Guide to
Preventive Services AMA
Calls for ‘Fair and Ethical’ Policy
on P4P Report: Public Hospitals Improve Diabetes Care
but Disparities Still Exist The American Journal of Surgery has published a study that credits
the 2002-2003 National Surgical Infection Prevention Collaborative with
making significant reductions in surgical site infection rates for the
56 hospitals from 50 states that participated in the collaborative. The year-long
collaborative involving 35,000 surgical cases was sponsored by the
Centers for Medicare & Medicare
Services (CMS) and led by Qualis Health, the Quality Improvement Organization
(QIO) for Washington, Alaska, and Idaho. The 44 hospitals that provided full data on their participation in the
collaborative reduced their surgical site infection rate by 27%. All teams in the Collaborative agreed to focus on improving performance
on three processes that CMS uses as national quality measures: administration
of antibiotics within 60 minutes prior to surgical incision, use of appropriate
antibiotics, and discontinuation of antibiotics within 24 hours of the
end of surgery. Most of the teams also worked on improving performance on one or more
of the following: control of glucose levels during surgery, avoiding
hypothermia during surgery, use of supplemental oxygen during surgery
and recovery, and clipping rather than shaving the surgical site. Over the course of the collaborative, the median performance of participating
hospital teams improved on all process measures. The overall infection
rate fell more than a quarter, from 2.3% in the first three months of
the collaborative to 1.7% in the last three months. “These are landmark achievements in getting individuals in hospitals
to work with one another and with other hospitals to share their data
and good ideas,” said an American Journal of Surgery editorial
that accompanied the article. Results
of the collaborative drew praise from CMS administrator Mark McClellan
and IHI president Don Berwick, who said: “This project
shows how hospitals working together and with QIOs can quickly make changes
that save lives.” QIO co-authors
of the study, “Hospitals Collaborate to Decrease
Surgical Site Infections,” include Jonathan Sugarman, CEO of Qualis
Health; Dale Bratlzler, Principal Clinical Coordinator at Oklahoma Foundation
for Medical Quality; and Susan Hausmann, Rosa Johnson, Donna Daniel,
Kathryn Bunt, and Greg Baumgardner of Qualis Health. The lead author
is E. Patchen Dellinger, a surgeon at the University of Washington. While the final results of QIO statewide SIP efforts have not yet been
announced by CMS, QIOs in more than 30 states have reported that hospitals
taking part state SIP collaboratives have shown significant improvement. AHQA’s
press release on the study is at http://www.ahqa.org/pub/media/159_678_5198.CFM AHQA released
a statement and conducted a media briefing to contest the methodology
and relevance of findings presented in a JAMA article, “Do
QIOs Improve the Quality of Hospital Care for Medicare Beneficiaries,” written
by Claire Snyder and Gerard Anderson of Johns Hopkins School of Public
Health. The article
looked at hospital data from 4 states during 1998-2001 and concluded
that “Hospitals
that participate with the QIO program are not more likely to show improvement
on quality indicators than hospitals that do not participate.” While the
article has yet received little or no attention in the mainstream media,
its findings were carried by trade press available to policymakers
in Washington and professional audiences in general. Most of those
articles also included AHQA’s criticism of the study. “The summary conclusion of the JAMA article implies that the
research presented in the article is an evaluation of the QIO program
as it exists today. That is clearly not true,” AHQA said in a statement
by Executive Vice President David Schulke. “We hope and expect
that JAMA will correct the misimpression created by this article by publishing
the results of QIO efforts during the most recent work cycle, 2002-2005.
Those results will be available from CMS later this year.” The statement
also stressed that: “The methodology used in the
JAMA article to assess the impact of QIO hospital work would be a reasonable
approach to take today, but was not feasible in 1999-2001. During that
period , the design of the QIO work assignment made it extremely difficult
to assess the contribution of QIOs to nationwide hospital quality improvement
documented in an earlier JAMA article. The new study sheds little new
light on this issue.” “The data used to assess the QIOs’ impact in the JAMA study
was gathered at the halfway point in the three year QIO contract,” Schulke
noted, pointing out that the article does not acknowledge this. Qualis
Health CEO Jonathan Sugarman, president of AHQA, issued a statement
stressing the inadequacy of using only half the data from the 1998-2001
contract period: “This is roughly equivalent to judging a baker’s
skill by tasting a pie removed from the oven half way through the baking
time,” he said. Letters to the JAMA editor are being prepared by QIO leaders and AHQA.
AHQA is also pressing JAMA for a retraction based on inadequacy of the
research for the article. The full AHQA statement is available at: http://www.ahqa.org/pub/media/159_678_5197.CFM. One major
trade press report on the article is at: http://www.ahqa.org/pub/uploads/JAMA_QIO_study_050615.pdf. The Agency for Healthcare Research and Quality recently announced that
it will award over $8 million in funding over two years for 15 projects
that are designed to help clinicians, facilities, and patients implement
evidence-based patient safety practices. The 15 Partnerships in Implementing Patient Safety grants will use interventions
that are ready to be implemented now and will have both immediate and
long-term impact. More than half the projects focus on reducing medication
errors and many will apply interventions to improve health care team
communications, also a well-known source of errors. A key component of the projects is the development of a set of free,
publicly available toolkits for health care providers and others that
will share lessons learned on how to best implement patient safety practices.
For example, toolkits will be developed to help patients keep track of
their prescription medicines when they are admitted to or discharged
from the hospital. AHRQ Director
Caroyn M. Clancy, MD said, “Providers across the
country will have access to the kinds of practical tools they have been
waiting for to implement in their own facilities--ones that have been
proven to be effective.” The projects span a wide spectrum of settings and populations, including
small rural facilities and large urban hospitals, clinics, and emergency
departments, as well as pediatric and geriatric patients. Because some
of the projects involve health systems that have locations in multiple
states, the research projects will span nearly half of the states. A complete
list of the 15 projects is available at: http://www.ahrq.gov/qual/pips.htm. The Agency for Healthcare Research and Quality has released The
Guide to Clinical Preventive Services 2005, which highlights evidence-based
recommendations for screening tests, counseling, and preventive medications
for adults and children in the primary care setting. The guide includes recommendations from the U.S. Preventive Services
Task Force on prevention and early detection for cancer; heart and vascular
diseases; infectious diseases; injury and violence; mental health conditions
and substance abuse; metabolic, nutritional, and endocrine conditions;
musculoskeletal conditions; and obstetric and gynecological conditions. The guide presents the recommendations in an indexed, easy-to-use format,
with at-a-glance charts making it easier for clinicians to consult them
in their daily practice. Task Force recommendations are also available
as a clinical decision support tool for personal digital assistants (PDAs),
called the Interactive Preventive Services Selector. This free application
is available for download from the AHRQ Web site at http://pda.ahrq.gov. The Task Force, supported by AHRQ, is the leading independent panel
of private-sector experts in prevention and primary care. Free single copies of the new guide are available free of charge at www.ahrq.gov/clinic/pocketgd.htm,
by calling the AHRQ Publications Clearinghouse at 1-800-358-9295 or by
sending an E-mail to ahrqpubs@ahrq.gov. The American
Medical Association (AMA) has adopted a new policy on pay-for-performance
(P4P), calling for pilot testing prior to implementation of P4P programs
and reasserting the need for programs not to penalize physicians based
on factors outside of the physician’s control. The AMA
policy states that “ Fair and ethical PFP programs are
patient-centered and link evidence-based performance measures to financial
incentives.” The policy defines five principles of a “fair
and ethical” P4P program: “The primary goal of any pay-for-performance program must be
to promote quality patient care,” said AMA Secretary John H. Armstrong,
MD, “We believe that pay-for-performance programs done properly
have the potential to improve patient care, but if done improperly can
harm patients." The AMA policy also called for evidence-based quality measures to be
the primary measures used in any program, with those performance measures
being prospectively defined and developed collaboratively across physician
specialties. A complete
set of the AMA’s updated principles and guidelines
for pay-for-performance programs are available at: http://www.ama-assn.org/ama/pub/category/15254.html The AMA
also passed a new policy to increase the participation of minority
patients in clinical trials. A recent
report finds that outcomes for patients with diabetes treated at the
nation’s
public hospitals are comparable to, and in some cases, better than
the national averages for diabetes care, despite a higher volume of
care for the underserved at public hospitals The study, “Caring for Patients with Diabetes in Safety Net Hospitals
and Health Systems,” was conducted by the Consortium for Quality
Improvement in Safety Net Hospitals and Health Systems, convened by the
National Public Health and Hospital Institute, and was funded by The
Commonwealth Fund. It is the first assessment of how public hospitals
manage diabetes care for a diverse and underserved population, and is
part of an effort to improve care for patients with chronic conditions. The Findings Two-thirds of patients at hospitals involved in the study exhibited
moderate control of their diabetes, and patients had similar or better
cholesterol levels than patients in national surveys. However, black
and Latino patients in the study were less likely than their white counterparts
to have well-controlled diabetes, and uninsured patients received less
care. Services associated with significantly better health outcomes for diabetes
patients at the target hospitals included American Diabetes Association
(ADA)-certified diabetes education programs and satellite pharmacy clinics. Other key findings: Common characteristics of the consortium hospitals that were likely
to affect the quality of diabetes-related care: Hospitals in the consortium included: Cambridge Health Alliance, Cambridge,
MA; Community Health Network of San Francisco/San Francisco General Hospital;
Cook County Bureau of Health Services, Chicago; Grady Health System,
Atlanta, GA; Harborview Medical Center, Seattle, WA; LSU/Medical Center
of Louisiana, New Orleans; and Memorial Healthcare System, Hollywood , FL.  Home :: Inside AHQA :: For The Media :: Public Policy :: Advancing Quality :: Quality Connections :: SiteMap
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