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Study: High
Quality Care Helps Elderly Survive First-Ever ‘Interoperable’ Patient Safety
Standards Endorsed by NQF Electronic Bracelet Can Prevent Medication Errors ACCP Releases First Guidelines for Postoperative AF CMS to Require Immunization in Nursing Homes NQF Endorses Performance Standards for Ambulatory Care Report Highlights HIT Legal Barriers A study in Annals of Internal Medicine indicates
that providing a high quality of care based on established quality
indicators can significantly increase survival for elderly patients.
The authors of “Quality
of Care Is Associated with Survival in Vulnerable Older Patients” found
that 28 percent of older patients who receive substandard care according
to quality indicators for 22 clinical conditions died within a three
year period compared to 18 percent of their peers who received higher
quality of care. The findings also indicate a “dose response” relationship
between quality of care and mortality -- as the amount of high quality
care increased, survival increased. The study
is “the
first to show the predictive validity of a broad-based, process-of-care
quality measurement system using patient survival among community dwelling older
persons,” the
authors said. In an accompanying
editorial, Dr. Sankey V. Williams of the University of Pennsylvania
notes that the study is important because, “we
don’t know much about the relationship between the process of care
and patient outcomes in the real world outside interventional research
studies, and most real world quality improvement efforts measure the
process of care because it is easier than measuring outcomes.” The findings,
Williams says, “are important because they provide
evidence that quality improvement efforts that focus on the process of
care improve patient outcomes.” The authors
suggest that an important next step is to “evaluate
whether interventions can be implemented that improve the delivery of
these processes” and whether they actually improve survival for
vulnerable older patients. Read the
abstract at: http://www.annals.org/cgi/content/abstract/143/4/274 The National Quality Forum (NQF) has endorsed a voluntary system for
classifying patient safety incidents to enable different patient safety
reporting systems to communicate with each other. The new National Voluntary
Consensus Standard for a patient safety taxonomy will also allow users
to analyze and compare information across systems to learn from patient
safety events. Many health
care providers, professional organizations, and some states and agencies
of the federal government have implemented patient safety reporting
systems; unfortunately, the ability to learn from these systems is
limited because they do not “talk” to each other. The NQF
project addresses this by endorsing a specific classification system
(or taxonomy)—the Patient Safety Event Taxonomy (PSET)—that
will enable interoperability of reporting systems and comparability of
information across systems and over time. PSET represents the consensus of more than 260 health care providers,
consumer groups, professional associations, purchasers, federal agencies,
and research and quality improvement organizations. To support full implementation of the taxonomy, NQF also endorsed definitions
of key patient safety terms, standard reporting elements for patient
safety reporting systems, and recommendations for principles to guide
improvement of the taxonomy. PSET was developed by the Joint Commission on Accreditation of Healthcare
Organizations with the assistance of a work group comprising representatives
of provider and health professional organizations and the federal government.
For more information, visit www.qualityforum.org. A British
university student has created an electronic bracelet designed to help
reduce medication errors in hospital patients. Nicknamed “Brilliant,” the
bracelet contains a chip that is programmed at hospital admission with
the patient’s medical details and medications. During the
patient’s hospital stay, the chip can record time and
dosage of medications given – reducing the chance of overdose.
It also contains an electronic sensor that scans tags built into medication
packaging and produces a visual warning when the wrong medication is
used. This information can be downloaded on to a computer at the end
of the patient’s hospital stay for billing and auditing purposes.
The bracelet can be reused by simply wiping the information from the
chip. A prototype has been tested at a private hospital in England. Additional
work on the bracelet is expected before testing on a larger scale begins.
For more information, contact Victoria Lefroy in the UK at victoria@fusepr.com or
Kate Lawson at kate@fusepr.com. The American College of Chest Physicians (ACCP) has released the first
evidence-based clinical practice guidelines for the prevention and management
of postoperative atrial fibrillation (AF), a common condition that occurs
increasingly with age and is one of the most frequent complications of
cardiac surgery. Published in CHEST,
the peer-reviewed journal of the ACCP, the guidelines offer specific
recommendations on cardiac pacing, anticoagulation therapy, pharmaceutical
prophylaxis, intra-operative interventions, and pharmacologic control
of ventricular rate and rhythm. “Over one
third of patients suffer from AF after cardiac surgery, which is associated
with a higher risk of operative morbidity, increased hospital stay, and
increased hospital cost,” said Guidelines Co-Chair Peter P. McKeown,
MBBS, MPH, MPA, FCCP, Veterans Affairs Medical Center, Asheville, NC. The guidelines
were developed by a multidisciplinary panel of experts in the fields
of cardiothoracic surgery, cardiology, anesthesiology, and epidemiology
including representatives from the ACCP, the American College of Cardiology,
the Society of Thoracic Surgeons, and the American College of Surgeons. For more information or to order a copy of the guidelines, contact
the ACCP at (800) 343-ACCP (2227), or visit http://www.chestnet.org. The Centers
for Medicare & Medicaid Services (CMS) announced that
the agency intended to propose a rule that requires n ursing homes serving
Medicare and Medicaid patients to provide annual immunizations against
influenza and one-time immunization against pneumococcal disease to all
residents if they want to continue in the programs (unless refused by
the patient or patient’s family or for medical reasons). The rule was released in the August 15 Federal Register. Because
of the impending influenza season, this expedited proposed rule will
have a 15-day comment period.To review the proposal, go to: www.gpo.gov. CMS received
input from the Centers for Disease Control and Prevention (CDC) and
two of the nation’s largest nursing home industry trade
groups, the American Association of Homes and Services for the Aging
and the American Health Care Association, in developing the proposed
rule. The agency
hopes the regulation will raise both influenza and bacterial pneumonia
vaccination rates to 90 percent from 65 and 38 percent respectively. As
an added incentive, CMS increased the average Medicare payment rate for
administering each shot from $8 to $18 in January. Although
not required in the proposed regulation, CMS is also encouraging nursing
homes to provide influenza vaccine to their health care workers. It
has also been shown that immunizing nursing home workers reduces mortality
rates among residents of long-term care facilities. Research from
last year’s flu season revealed that only 36 percent of all healthcare
workers were vaccinated against the illness. About two
million Americans, most age 65 years or older, live in long-term care
facilities. Those over 65 account for more than 90 percent of influenza-related
deaths in the United States and elderly nursing home residents are particularly
vulnerable to influenza-related complications. The elderly are also more
likely than younger individuals to die from pneumonia. The National Quality Forum (NQF) announced the endorsement of a standardized
set of measures for gauging and publicly reporting the quality of ambulatory
care. Until now, there have been few agreed upon quality measures specifically
aimed at measuring the performance of outpatient care. As public reporting of hospital, nursing home, and home health care
quality has been implemented nationally, the lack of information about
quality of physician performance in the ambulatory care setting has emerged
as a huge gap that must be bridged. The NQF project addresses this by
creating the National Voluntary Consensus Standards for Ambulatory Care. The NQF
Board of Directors approved 36 performance measures and three recommendations,
all of which were vetted through NQF’s formal
Consensus Development Process with multiple stakeholder input, to achieve
special legal standing as voluntary consensus standards. The standards represent measures of structure, process, and outcome
that have been linked by evidence to quality of ambulatory care. Additionally,
each measure was evaluated according to NQF-endorsed criteria of importance,
scientific soundness, feasibility, and usability. The approved measures apply to treatment for asthma and respiratory
illness; depression; bone conditions; heart disease and heart failure; hypertension; prenatal
care; and preventive care and screening. For more
information on the measures, visit: http://www.qualityforum.org/ambulatory_care_evals.html A report
released by the Robert Wood Johnson Foundation (RWJF) and the George
Washington University School of Public Health and Health Services (GW),
identifies the legal issues that arise with the development of more
and better health care information. “Charting the Legal Environment
of Health Information,” is the first phase of a project that shows
real and perceived legal barriers that could dramatically hinder efforts
to use critical information about a patient’s health care for quality
improvement. “Successfully adapting health care to an information age will
take changes in the legal system” the authors conclude, “Revising
the law to accommodate and even promote change is a challenge, especially
when our legal system is as complex as health care itself.” In the next phase, the GW team will develop policy recommendations to
overcome potential legal barriers to using patient information for health
care quality improvement and reducing disparities. Michael
Painter, J.D., M.D., RWJF senior program officer noted “We
believe it’s important to identify the various legal barriers to
quality improvement and propose some reasonable next steps. We also believe
that if we can do those things, leaders from our health care and legal
systems will make the law assist, rather than hinder, a pragmatic, safe
redesign of American health care.” The report is based on extensive research and consultation with experts
over a year-long period. Some key findings include: Two versions
of “Charting the Legal Environment of Health Information”—a
summary and the full version—are now available at www.gwumc.edu/sphhs/healthpolicy and www.rwjf.org. A study
in Journal of the American Medical Association, “Clinical
Practice Guidelines and Quality of Care for Older Patients with Multiple
Comorbid Diseases,” indicates that current clinical practice guidelines
(CPGs) are not written to accommodate older adults with multiple illnesses.
Researchers applied multiple single disease CPGs to a hypothetical 79
year old woman with five common chronic diseases and found that most
CPGs did not adequately address comorbidities in this age group and that
if the relevant CPGs were followed, the patient would be prescribed 12
medications with a complicated care regimen. Read the abstract at: http://jama.ama-assn.org/cgi/content/short/294/6/716 In a study in Critical Care Medicine, researchers
find that over 20 percent of the patients admitted to two intensive care
units (ICUs) experienced an adverse event and almost half of the events
(45 percent) were preventable. A significant number of the adverse events
involved medications—most commonly, giving patients the wrong dose.
Over 90 percent of all incidents occurred during routine care, not on
admission or during an emergency intervention. The study, “The
Critical Care Safety Study: The incidence and nature of adverse events
and serious medical errors in intensive care,” was sponsored by
the Agency for Healthcare Research and Quality. An abstract is available
at: http://www.ccmjournal.com. In an Archives of Internal Medicine study,
researchers use national data from 14 million inpatient stays in 2000
and 2001 to estimate the burden of Staphylococcus aureus infections.
The study found that patients with infections had longer hospital stays
and five times the risk of death in the hospital than other patients
contributing to increased hospitalization costs and preventable deaths.
Read an abstract of “The Burden of Staphylococcus aureus Infections
on Hospitals in the United States” at: http://archinte.ama-assn.org/cgi/content/abstract/165/15/1756 In “ A Reminder Reduces Urinary Catheterization in Hospitalized
Patients,” published in the Joint Commission Journal
on Quality and Patient Safety , researchers say they have
reduced the length of use of urinary catheters by putting reminder stickers
on patients’ charts that require physicians to reauthorize catheter
use. Prolonged use of a urinary catheter increases the risk of infection.
To purchase a copy of the study, visit: http://www.ingentaconnect.com/content/jcaho/jcjqs In the article, “Efficacy of Inhaled Insulin in Patients with
Type 2 Diabetes not Controlled With Diet and Exercise” in Diabetes
Care, researchers conclude that inhaled insulin “could
be an effective therapy for people with Type 2 diabetes early in the
course of their disease.” Read an abstract at: http://care.diabetesjournals.org/cgi/content/abstract/28/8/1922 In Archives of Neurology,
researchers explain that for patients who regularly take aspirin because
they have an elevated risk of heart attack abruptly stopping the therapy
can increase chances of suffering a stroke. “These results highlight the importance
of aspirin therapy compliance,” conclude the authors of “Effect
of Discontinuing Aspirin Therapy on the Risk of Brain Ischemic Stroke.” Read
an abstract at: http://archneur.ama-assn.org/cgi/content/abstract/62/8/1217 A study in the Archives of Internal Medicine indicates
that when patients trust their doctor, they are more likely to continue
taking medications as prescribed during financial hardship rather than
cut back on usage to save money. The authors of “The Role of Patient-Physician
Trust in Moderating Medication Non-adherence Due to Cost Pressures” conclude
that “ addressing non-cost barriers to adherence may reduce rates
of cost-related medication underuse.” Read the study abstract at: http://archinte.ama-assn.org/cgi/content/abstract/165/15/1749  Home :: Inside AHQA :: For The Media :: Public Policy :: Advancing Quality :: Quality Connections :: SiteMap
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