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Two New Senate Bills Aim to Spur Health Care
Quality Improvement President Bush Signs Patient Navigator Bill Study: Greater Need for Use of Evidence-based
Medicine A Better Treatment for Hypertension, Heart
Disease in Type 2 Diabetics Report Calls for National Standards of Practice
on Medical Interpreters Study Looks at Prevalence of ADEs Snapshots: Local Efforts to Improve Health
Care Four senators
recently introduced two bipartisan bills to Congress designed to work
in tandem to speed improvements in the country’s health
care quality: the Medicare Value Purchasing Act of 2005 (MVP) proposed
by Senate Finance Committee Chairman Chuck Grassley (R-IA) and the committee’s
ranking minority member Max Baucus (D-MT) and the Better Healthcare Through
Information Technology Act of 2005 sponsored by Senate Health, Education,
Labor, and Pensions Committee Chairman Michael B. Enzi (R-WY) and committee
ranking minority member Edward M. Kennedy (D-MA). MVP aims to add a pay-for-performance system to Medicare. The measure
calls for rewarding health care providers with higher Medicare payments
if they deliver care that meets or exceeds quality expectations. The MVP Act mandates that national quality measures be developed and
adopted by a consensus of diverse stakeholders and the Medicare payments
be tied to quality performance data. It also calls for examination of
data collection and reporting issues including increased transparency.
In the phased-in approach, Medicare payments would start at 1% and increase
to 2% over 5 years. In a statement
introducing the bill, Senator Grassley, citing reports by the Institute
of Medicine, MedPAC, and The Commonwealth Fund said, “What
we have is a systemic failure of Medicare payment systems to reward quality
and provide the incentives to invest more in health care information
technology and other efforts to improve health care quality. This bill
creates the financial incentives that reward those providers who deliver
that quality care today, and to those who make improvements where they
are needed,” Grassley added. Facilitating adoption of HIT, building a National Health Information
Technology Network, and supporting innovative approaches to health care
quality improvements are other key measures of the MVP Act. The Better Healthcare Through Information Technology Act of 2005 would
start the process of shifting health records from a paper-based system
to a secure electronic format to help patients, especially in rural areas,
keep track of medical records. “We’ve drafted a bill to bring the government and the private
sector together to make healthcare better, safer and more efficient by
accelerating the adoption of information technology across our healthcare
system,” said Enzi. President Bush has signed into law the Patient Navigator, Outreach and
Chronic Disease Prevention Act. The bill mandates a five-year demonstration
outreach and prevention program to provide trained counselors to help
chronically ill patients navigate the health care system. The House and
Senate passed the legislation by voice vote. The bill
authorizes $25 million in grant funds over the next five years to train
and deploy navigators to help patients overcome a wide variety of barriers
-- economic, cultural, geographic and others -- to obtaining prompt
diagnosis and treatment of chronic diseases. Health centers will play
a key role, along with the Office of Rural Health Policy, the National
Cancer Institute (NCI), and the Indian Health Service. The bill also
creates a year-round community outreach program to make people aware
of the need for prevention screenings, and uses “patient navigators” to
educate and empower patients in the health care system and help them
overcome cultural and language barriers. Patient navigators assist people with obtaining coverage through the
Medicaid system or other sources, gain access to cancer screenings or
counseling about disease prevention. Patient navigators will also help
patients get referrals for treatment or clinical trial options should
an abnormality be detected during a screening. The bill was sponsored by Sen. Kay Bailey Hutchison, R-TX, and Rep.
Robert Menendez, D-NJ. An Archives
of Internal Medicine study calls for “greater adherence
to evidence-based medicine in U.S. ambulatory settings.” The study
also finds that quality of care is not significantly associated with
the patient’s racial or ethnic background. Using national survey data, Stanford researchers assessed overall performance
and racial/ethnic disparities in private physician offices and hospital
outpatient departments in 1992 and 2002. They examined 23 outpatient
quality indicators, including appropriate antibiotic use, treatment of
depression, avoiding unnecessary screening, and avoiding inappropriate
medications in the elderly. Quality indicator performance was defined
as the percentage of applicable visits receiving appropriate care. Overall, the researchers found, changes between 1992 and 2002 were modest,
with significant improvements in six indicators: treatment of depression
(47 vs. 83 percent), statin use for hyperlipidemia [high blood lipid
levels] (10 vs. 37 percent), inhaled corticosteroid use for asthma in
adults (25 vs. 42 percent), and children (11 vs. 36 percent), avoiding
routine urinalysis during general medical examinations (63 vs.73 percent),
and avoiding inappropriate medications in the elderly (92 vs. 95 percent). The authors
did not find evidence of significant racial disparities as described
in other care settings. They conclude that “similar,
although less than optimal, care is being provided on a per-visit basis
regardless of patient racial/ethnic background.” The authors
conclude that “This study contributes to the ongoing
efforts to develop a national system for measuring and reporting the
quality of outpatient health care in the United States,” and that “large
gaps exist between actual clinical practices and evidence-based recommendations
in many areas of outpatient care.” They also found “limited
evidence that these performance gaps are closing as a result of proliferating
evidence-based practice guidelines.” An abstract of the article is available at: http://archinte.ama-assn.org/cgi/content/abstract/165/12/1354 Diuretics
(“water pills”)
work better than newer and more costly medicines in the treatment of
high blood pressure and prevention of some forms of heart disease in
people with type 2 diabetes, according to results from the Antihypertensive
and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT).
The latest results from ALLHAT, the largest hypertension clinical trial
ever conducted, were published in the June 27th issue of the Archives
of Internal Medicine. The study, conducted in 623 clinics and centers across the United States,
Canada, Puerto Rico, and the U.S. Virgin Islands, included 31,512 men
and women who were all 55 years old or older with stage 1 or stage 2
hypertension and at least one additional risk factor for coronary heart
disease. Participants were assigned to initial treatment with either
a calcium channel blocker (amlodipine), an ACE inhibitor (lisinopril)
or a diuretic (chlorthalidone). Compared with the ACE inhibitor and the calcium channel blocker, the
diuretic was: “Independent of diabetes status, our results suggest that diuretics
are better than ACE inhibitors and calcium channel blockers in preventing
certain cardiovascular disease complications-especially heart failure-during
initial treatment of high blood pressure,” says Whelton. The article is available on-line at http://archinte.ama-assn.org/ A new report
from the National Council on Interpreting in Health Care addresses
the need for national standards on medical interpreters. “The
Interpreter's World Tour: An Environmental Scan of Standards of Practice
for Interpreters,” funded by The Commonwealth Fund and The California
Endowment, supports the development of national standards of practice
for interpreters in health care that will guide training and lead to
larger numbers of skilled medical interpreters. In the report, Marjory Bancroft, MA, founder and director of Maryland-based
CrossCultural Communications, integrates nearly 150 documents from 25
countries in 11 different languages into a global snapshot that represents
standards of practice in interpreting within the U.S and around the world.
Among her findings: Bancroft
concludes that as a global leader in the interpreting profession, the
United States “may bear a particular responsibility to develop
national standards of practice for interpreters in health care.” The report is available at: http://www.calendow.org/index.stm In an article
published in the July edition of the Joint Commission Journal on Quality
and Patient Safety, lead author Chunliu Zhan, MD and colleagues suggest
that adverse drug events remain a significant threat to patient safety – despite
efforts to the contrary. The epidemiological
study, an analysis of 1995-2001 data from the National Ambulatory Medical
Care Survey and the National Hospital Ambulatory Medical Care Survey,
counted incidents where the first listed cause of injury were “visits for treating adverse drug events” or
VADEs -- a new term Zhan coined for the study. The researchers
calculated that 11 to 15 VADEs were made for every 1,000 U.S. residents.
The most common problems reported were dermatological symptoms, gastrointestinal
symptoms, and dizziness. Modern Physician, which reported on the study
June 30, says that Zhan acknowledged “Some
of these symptoms may be a side effect and not an ADE.” The Modern
Physician article concludes that “Although it found
a new way to look at an old problem, the study does not offer much in
the way of possible interventions, but Zhan said that wasn't its intent.
The objective, he said, was to do an epidemiological study to assess
the magnitude of the problem.” Across the country, health care facilities and providers are working
to find ways to improve patient safety and the quality of health care.
Some examples of initiatives underway: In
Detroit…On
May 31, The Detroit News reported that area hospitals are working to
reduce noise levels to improve patient comfort and ability to rest. Changes
include simple measures such as: dimming the lights, replacing noisy
paper towel dispensers, giving nurses cell phones (to eliminate over-head
paging), re-organizing maintenance/cleaning schedules, and limiting room
visits by care givers. Structural changes like enclosing the nurses’ station
in glass and adding insulation to noisy areas is also helping. One hospital
uses a big ear that changes colors depending on how loud it gets. In
Seattle…The
Washington Post reports, on June 3, that Virginia Mason Medical Center
in Seattle has adapted the Toyota manufacturing process to its new cancer
center, which is designed around themes of high quality, super-efficiency,
and putting the patient first. Errors are embraced as learning opportunities,
and every one of Virginia Mason's 5,000 employees is encouraged to offer
ideas. Since adopting the Toyota mind-set, the 350-bed hospital has saved
$6 million in planned capital investment, freed 13,000 square feet of
space, cut inventory costs by $360,000, reduced staff walking by 34 miles
a day, shortened bill-collection times, slashed infection rates, spun
off a new business and, perhaps most important, improved patient satisfaction.
Virginia Mason Medical Center’s website: http://www.virginiamason.org/default.asp In
New York…In
a June 3 press release, Montefiore Medical Center’s three emergency
departments (ED), one of the busiest on the entire East Coast, highlight
the results of a redesigned ED system. Among the many changes implemented
include: improved triage with multiple patient tracks that reduce wait
times, increased personal attention to waiting patients like comfort
items such as pillows and blankets, a “tea time” beverage
cart and hot meals at lunch and dinner. Outcomes for the most seriously
ill patients have improved as well as dramatically increased patient
satisfaction while hospital admissions from the ED have increased 30%.
Montefiore Medical Center’s website: http://www.montefiore.org/ In
Florida…The
Florida Times Union reports on June 7 that Orange Park Medical Center
has been able to cut down admission wait times for its most critical
patients by about 50 percent by redesigning an underused seven-room hospital
wing. Until recently, Orange Park experienced over-crowding at its 16-bed
intensive care unit – resulting in three or four patients being
held in the often chaotic emergency room because of a lack of space.
After identifying that an observation unit designed to monitor patients
after minor surgery had excess capacity, the hospital converted it into
a scaled-down version of an ICU for more stable patients. As a result
of the additional capacity, ICU patients at Orange Park have now cut
down their ER wait time from as much as 24 hours to about six hours or
less. Orange Park Medical Center’s website: http://www.opmedical.com/ In
Memphis…On
June 8, The Commercial Appeal reported that the University of Tennessee
Health Science Center received an $800,000 grant from the National Institutes
of Health to study whether alarms will help reduce the number of hospital
patients injured in falls. The three-year study will compare the use
of alarms that alert hospital staff if patients try to leave a bed or
chair unaided with existing fall-prevention strategies that rely on nursing
methods. Along with studying whether alarms prevent falls, the research
is also designed to determine if they reduce the use of restraints and
cut costs. University of Tennessee Health Sciences Center website: http://www.utmem.edu/  Home :: Inside AHQA :: For The Media :: Public Policy :: Advancing Quality :: Quality Connections :: SiteMap
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