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JAMA Publishes Rebuttals to Article Critical
of QIOs Survey Shows How Americans Determine Health
Care Quality LHCR Launches Nationwide Search, Website for
Displaced LA MDs AHRQ Holds Meetings to Educate Public Publication Helps Consumers Respond to a Diagnosis Report Projects Significant Savings for Seniors
Enrolled in Part D Study Shows Mammography Reduces Breast Cancer
Deaths BCBS Program Reorganizes Public Quality Data
to Help Hospitals Improve AMA Primer
Addresses Immunization and Disparities Report:
Chasm Growing between Best and Worst Hospitals In letters to the editor published in the October 24 issue of the Journal
of the American Medical Association (JAMA,) QIO leaders rebutted
assertions made in a June 15 JAMA study that questioned the effectiveness
of the QIO program. AHQA president Jonathan Sugarman, MD, MPH, former
president Dale Bratzler, DO, MPH, and MetaStar senior vice president
Jay Gold, MD, JD, MPH, and Former Office of Clinical Quality and Standards
chief Stephen Jencks, MD, MPH, pointed out several key flaws in the
study’s methodology. The June
article, “Do Quality Improvement Organizations Improve
the Quality of Hospital Care for Medicare Beneficiaries?,” by Claire
Snyder, PhD, and Gerard Anderson, PhD, both of Johns Hopkins Bloomberg
School of Public Health, concluded that “h ospitals that participate
with the QIO program are not more likely to show improvement on quality
indicators than hospitals that do not participate.” In a letter
also in this week’s JAMA, Snyder and Anderson concede
that many points made by Drs. Sugarman, Jencks, Bratzler and Gold are “certainly
valid.” Data discrepancies The Snyder/Anderson
analysis was based on hospital performance quality data from five of
the 53 QIO programs during the 1998-2001 SOW6. In their article, Snyder
and Anderson said the remeasurement data was gathered “toward
the end of the QIOs’ contract cycle”. In the letters published
in JAMA this week, QIO leaders point out that the remeasurement data
covered only the first half of the 6 th SOW period, when many hospitals’ performance
may not yet have improved significantly. “We believe the data set the authors analyzed could not be used
to reach their principal conclusion,” said Sugarman. “The
effectiveness of a three-year effort cannot be judged using information
from only the first 17 months of that period.” Sugarman and other
experts also point out that as the work cycle progressed, efforts to
improve quality accelerated in many hospitals. Lack of control group The Snyder/Anderson
study evaluated QIOs by “comparing the improvement
in the quality of care of patients in hospitals that actively participated
with the QIOs versus hospitals that did not.” But QIO leaders wrote
in JAMA this week that this basis for comparison cannot be used to evaluate
QIO efforts with hospitals in the SOW6 because during that scope of work
Medicare required QIOs to work with all hospitals. “There are no real non-intervention facilities,” writes
Jencks, who headed the QIO program during the study period. “QIOs
had some contact with essentially all hospitals and often worked with
an individual hospital on one topic but not another.” In a 2003
JAMA article, Jencks used Medicare data from the full three-year SOW6
cycle to show that hospitals broadly improved quality of care. Snyder
and Anderson responded to this week’s letters by stating that their
data is the same as that used by Jencks to suggest “the improved
care is consistent with the activities of the QIOs over this period.” In
the Jencks study, however, the authors explicitly stated that the data “do
not provide conclusive evidence” about the effectiveness of QIOs. “Generalizing from this underpowered study of a convenience sample
of 5 QIOs to the entire program of 53 QIOs, especially given the differences
the authors report among these 5 QIOs, is imprudent,” Jencks concluded
in his letter to JAMA this week. Read an abstract of the Snyder/Anderson study: http://jama.ama-assn.org/cgi/content/abstract/293/23/2900 Read the letters to the editor: http://jama.ama-assn.org/cgi/content/extract/294/16/2028 The 2005
Health Confidence Survey (HCS), conducted by the Employee Benefit Research
Institute (EBRI) and Mathew Greenwald & Associates, a public
opinion and market research organization, shows that the majority of
Americans are satisfied with the quality of health care they received
within the last two years. Survey respondents ranked factors they use
in determining the quality of health care they receive. Relatively few
tied cost to quality. Almost
all Americans consider characteristics of their provider very important
in determining the quality of health care they receive, the survey
said. Factors deemed important include: the skill, experience, and
training of their doctors (97%); their doctors’ communications
skills and willingness to listen (90%); the degree of control patients
have in making health care decisions (90%); and the respect they receive
from their health care provider (80%). Respondents also reported that
system factors are important: the timeliness of getting care (89%); ease
of getting care and treatments (85%), the ability of the doctor or hospital
to access their complete medical records (81%), the cost they pay for
health care and prescription drugs (79%), and independent information
about the quality of care provided by their doctor or hospital (74%). The survey showed that the majority of Americans feel that increased
access to information about the effectiveness of treatment options (65%)
and the quality of health care providers (59%) would improve the quality
of the health care they receive. However, fewer reported that more information
about the actual cost of services would improve quality (28%). In addition,
researchers found that increases in health care costs have caused most
insured Americans to change the way they use health care – some
positive such as using generic drugs (79%) or taking better care of
themselves (71%), and others negative. Negative changes, which were
more commonly seen in low-income households, include not taking prescribed
medications (33% compared to 14% of high-income households) or delaying
physician visits (49% versus 29%). The 20 minute telephone survey was conducted between June 21 to Aug,
6 with 1,003 individuals age 21 and older. The margin of error is plus
or minus 3 percentage points. Results are available online at www.ebri.org. Louisiana
Health Care Review, Inc. (LHCR), the state’s QIO, launched
a nationwide search for Louisiana physicians displaced by Hurricane Katrina.
Through a joint effort with MD Technologies and numerous other health
care partners across Louisiana, LHCR has developed www.FindLADocs.com,
a registry for displaced Louisiana physicians and a point of connection
for their patients. Physicians using www.FindLADocs.com will
be able to register for a special email account to foster communication
between the physician and their patients or health care providers across
the nation. The site will collect each physician’s current location
and contact information, information on their plans to return to the
devastated area, and what assistance they may need when returning to
practice. In addition, the site provides links to a number of resources
and information to assist doctors in re-establishing their practices. For more
information or to obtain a web button for your organization’s
website, contact Cathy Lewis at clewis@lhcr.org The Agency
for Healthcare Research and Quality (AHRQ) continues its series of
regional town hall meetings to educate consumers about health care
quality. “Making Health Care Safer: What You Need to Know” will
be held on Monday, October 31 in Oklahoma City, OK, from 10 AM to 1 PM
and on Tuesday, November 8 in Philadelphia, PA from 5:30 to 8:30 PM.
Both sessions are free and open to the public. These meetings will feature an interactive discussion with Dr. Carolyn
Clancy, Director of AHRQ; Trudy Lieberman, Director of the Center for
Consumer Health Choices, Consumer Reports; and audience participants.
Each event will conclude with an armchair panel and audience discussion
of local quality improvement and disparities reduction initiatives. Dale Bratzler,
DO, MPH, Principal Clinical Investigator at the Oklahoma Foundation
for Medical Quality, the state’s QIO, and former president
of AHQA, will serve as a panelist during the Oklahoma meeting. AHRQ’s newly released Guide to Health Care Quality: How to know
it when you see it, the Agency’s consumer-directed publication
designed to educate the public about health care quality will also be
featured at the meetings. To register, Oklahoma : http://www.hsrnet.net/ahrq/townhall/ok/index.htm Philadelphia
: http://www.hsrnet.net/ahrq/townhall/pa/index.htm The Agency
for Healthcare Research and Quality (AHRQ) recently released a new
publication, “Next Steps After Your Diagnosis: Finding Information
and Support,” to help consumers who have been diagnosed with an
illness learn more about their condition and treatment options. The booklet
is part of AHRQ’s new consumer education campaign to help people
take a more active role in their own health care. Included in the booklet is a list of 10 important questions to ask your
doctor when you receive a diagnosis. The questions are designed to help
individuals understand their disease or condition, how it might be treated,
and what they need to know before making treatment decisions. Selected
organizations and other resources, such as Web site addresses and phone
numbers, are also included to help provide additional information on
current medical research, clinical trials, and outcomes research about
certain conditions and treatment options. AHRQ recently received more than 11,000 requests for the booklet after
an article about it appeared in Parade magazine. To receive
a copy, contact ahrqpubs@ahrq.gov.
The publication is also available online at: http://www.ahrq.gov/consumer/diaginfo.htm A new report
from Medicare Today projects that Medicare’s prescription
drug benefit will greatly increase the number of seniors with catastrophic
health insurance and potentially reduce their out-of-pocket expenses.
Medicare Today is a group of more than 350 organizations that work together
to explain Medicare benefits through grassroots efforts. The report, based on US Census and Medicare data shows that: The full report is available at: http://www.medicaretoday.org/clientuploads/directory/toolbox_resources/ In the study, “Effect of Screening and Adjuvant Therapy on Mortality
from Breast Cancer,” published in the October 27th issue of the New
England Journal of Medicine (NEJM), researchers used seven independent
statistical models to prove that “both screening mammography and
treatment have helped reduce the rate of death from breast cancer in
the United States.” The New York Times reports that in 1990, 49.7 in 100,000 women
ages 40-75 died of breast cancer -- by 2000, the death rate had dropped
to 38 per 100,000. Cancer researchers and advocates have long debated
whether the decline is attributable to early detection through mammography
or powerful new drug treatments. To resolve the issue, the National Cancer
Institute asked seven research teams to explain the recent decline in
breast cancer deaths. According to the Times,
researchers found “28 to 65 percent
of the sharp decrease in breast cancer deaths from 1990 to 2000 was due
to mammograms. The rest was attributed to powerful new drugs to treat
breast cancer.” Also in
the October 27 th issue of the NEJM is a letter to the editor, “Damage
to Pacemaker Lead during Mammography,” by physician Mark M. Sherman,
MD, of Springfield , MA . Citing the case of a woman whose pacemaker
was apparently damaged during a routine mammography, Dr. Sherman urges
health care providers to pay “strict attention” during mammographic
examination in women with cardiac pacemakers to avoid possibly damaging
the pacemaker. For more information, http://content.nejm.org/ The Blue Cross and Blue Shield Association (BCBSA) has announced a new
national Network Hospital Measurement pilot program that will provide
quarterly performance reports to hospitals and employers in an effort
to encourage the use of publicly available quality data for the improvement
of hospital care. The reports
use clinical measures from the Centers for Medicare & Medicaid
Services, the Joint Commission on Accreditation of Healthcare Organizations
(JCAHO), and patient safety indicator measures from the Agency for Healthcare
Research and Quality. The data is reorganized into an information resource
to support local hospital efforts to improve care quality in collaboration
with Blue Cross and Blue Shield companies. In this way, the pilot program
creates no new reporting burden on health care providers. “This initiative is creating a whole new way of looking at quality
data,” said Dennis O’Leary, president and CEO of JCAHO. “The
Blues are taking existing quality data and adding context, creating a
valuable tool for hospitals that can help them provide more effective
care for their patients.” Eighteen
Blue Cross and Blue Shield companies, representing more than 80 percent
of the collective 93 million Blue subscribers, are participating in
the Network Hospital Measurement pilot program. “Our mission
is to improve the consistency of these proven, evidence-based treatments
at hospitals across the nation,” said Scott P. Serota, BCBSA’s
president and CEO. For more information, contact Chris Hamrick at BCBSA at 312-297-5954. A new primer
is available from the American Medical Association (AMA) to help physicians
improve immunization rates and reduce health care disparities. “ Roadmaps for Clinical Practice, Improving Immunization:
Addressing Racial and Ethnic Populations” is available on the AMA
website; physicians completing the primer are eligible for continuing
medical education credits. The four-booklet primer provides clinical strategies and tools to help
physicians address v accine-preventable deaths in underserved populations.
It includes recommendations for reporting guidelines for vaccine-preventable
diseases; information on handling, administering and storing vaccine;
case scenarios; strategies and solutions to help physicians address the
specific needs of minority populations; and helpful resources. The primer
also contains important information for patients and their families,
including immunization schedules for both children and adults. The primer is available online at www.ama-assn.org/go/roadmaps. The 8 th
annual “ HealthGrades Hospital Quality in America Study” shows
that the lives of 273,137 Medicare beneficiaries could have potentially
been saved if all hospitals nationwide performed at the level of a 5-star
rated hospital across 18 of the procedures and diagnoses studied from
2002 through 2004. Fifty percent of these potentially preventable deaths
were associated with just four diagnoses: heart failure, community acquired
pneumonia, sepsis, and respiratory failure. According
to the report, a typical patient has a 65% lower chance of dying at
a 5-star rated hospital compared with the lowest-rated hospitals. That “quality chasm,” the HealthGrades study shows, is growing,
as the nation’s best-performing hospitals lowered their mortality
rates 45% faster than the poorest-performing hospitals over the same
time period. Overall mortality rates improved 12 percent with some of the better
outcomes associated with higher hospital volumes and those with more
intensivists staffing intensive care units but the degree of improvement
varied widely by procedure and diagnosis studied. For more information: www.healthgrades.com  Home :: Inside AHQA :: For The Media :: Public Policy :: Advancing Quality :: Quality Connections :: SiteMap
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