Quality Update for March 2, 2006

NQF and NCQHC Unite to Coordinate Quality Efforts Home Care Study Identifies Best Practices in Reducing Preventable Hospitalization ICU Collaborative Reports Success AMA to Develop Quality Measures for Physicians CMS Offers MDs Free Software to View and Print HIPAA 835s Study Compares Errors in CPOE/non-CPOE Facilities Survey IDs Barriers/Keys to EHR Adoption in Hospitals Study of EHR Adoption Process Reveals Barriers, Lessons NQF Seeks Potential Measures for Public Reporting of Nosocomial Infections Comments Requested on Dementia Care Standards PBS Documentary Shows Nursing Home Transformation NQF and NCQHC Unite to Coordinate Quality Efforts The National Quality Forum and the National Committee for Quality Health Care have joined forces to bring more alignment and coordination to the quality movement, the organizations recently announced. Janet Corrigan PhD, MBA, will serve as president and CEO of the new entity known as the National Quality Forum. According to a press release from NQF, key programs of both organizations will be enhanced, and strategic alliances with other organizations will be pursued. NQF’s board will consist of current board members, plus two new appointments drawn from the former NCQHC Board. NCQHC’s Executive Institute and quality award program will remain and become a new programmatic area within NQF. This area will be overseen by a newly created National Quality Health Care Advisory Committee, consisting of former NCQHC board members and others yet to be appointed. The chair of the Advisory Committee will serve in an ex-officio capacity on the NQF board. Corrigan, most recently president and CEO of NCQHC, has held senior positions at the Institute of Medicine, overseeing the organization’s quality portfolio, and at the National Committee for Quality Assurance (NCQA), where she is credited with leading the early development of NCQA’s HEDIS. Carolyn Clancy, MD, director, Agency for Healthcare Research and Quality said “Janet is the exact right person to help accelerate and focus this positive and critically important direction.” Back to top NQF Names Two New Directors to Board Earlier this month, NQF announced that Jeffrey L. Kang, MD, MPH, Chief Medical Officer of CIGNA HealthCare, and Peter V. Lee, JD, Chief Executive Officer of the Pacific Business Group on Health (PBGH), were named to the organization’s Board of Directors. Dr. Kang, who represents an organization whose medical plans cover nearly 10 million Americans, brings to the NQF Board of Directors the perspective of the health care payer community. Lee, a frequent speaker and expert commentator on national health care quality issues, brings the perspective of the health care purchaser/employer community. Kang is responsible for medical strategy and policy at CIGNA HealthCare, including evidence-based coverage decisions and quality measurement and improvement. From 1995 to 2002, Kang worked at the Centers for Medicare and Medicaid Services (CMS) in a variety of capacities. As Chief Clinical Officer at CMS, Kang provided oversight for the national quality improvement program and represented the agency on NQF’s Board when the Administrator was not available. Currently Kang co-chairs NQF’s Steering Committee on Standardizing Ambulatory Care Performance Measures. He also serves on the Institute of Medicine’s Subcommittee on Quality Improvement Organization Evaluation and is a board member of the eHealth Initiative. In 2004, Kang resigned as a public member of the AHQA Board of Directors to participate in the IOM QIO study committee. As the chief executive of PBGH, a not-for-profit coalition of more than 50 large private- and public-sector health care purchasers headquartered in San Francisco, California, Lee oversees efforts to continuously improve the value of health care by increasing access to high quality care while controlling costs. PBGH promotes providing consumers with standardized comparative quality information and developing methods to assess and communicate the quality of care delivered by health plans, medical groups, and hospitals. For more information, visit: http://www.qualityforum.org. Back to top Home Care Study Identifies Best Practices in Reducing Preventable Hospitalization The January 2006 study, “Briggs National Quality Improvement/Hospitalization Reduction Study,” surveys the current landscape of strategies used to reduce preventable hospitalization and identifies best practices. Using the March 3, 2005 Home Health Compare scores, researchers identified 707 home care agencies whose scores placed them in the top 10% of all home care agencies in the preventable hospitalization category. Collectively, the agencies’ average score was 19%, while the national average is 28%.—unchanged since November 2003. The researchers identified five major characteristics of home care agencies that successfully lowered their preventable hospitalization rates. They are: Most successful agencies used one or more of 15 strategies identified in the study. Success was not seen in the implementation of the strategies themselves, but in how they were implemented. Successful agencies were not passive. Three strategies, falls prevention, front loading visits, and improved management culture and support, were used by more than 60% of respondents. Most successful agencies used more than one strategy – averaging 6.4 strategies. The report provides a breakdown of the 15 strategies currently in use to prevent hospitalization. For each strategy, the report includes a definition, percentage of those currently using the strategy, why the strategy is important, recommendations, additional considerations, and a resource list. The study was co-sponsored by the National Association for Home Care & Hospice and Fazzi Associates, a national consulting and research firm that has conducted extensive national studies on an array of home care related issues. A list of the names of the strategies includes: fall prevention, front loading visits, management culture and support, 24-hour availability/response system, medication management, case management, patient/caregiver education, special support services, disease management, physician relationships, data driven strategies, safety and risk assessment, discharge planning staff, emergency room staff, and telehealth. More information on the actual content of the strategies can be obtained in the study: http://www.nahc.org/NAHC/CaringComm/eNAHCReport/datacharts/hospredstudy.pdf Back to top ICU Collaborative Reports Success The Maryland Patient Safety Center’s (MPSC) Intensive Care Unit Safety Culture Collaborative reported earlier this month that hospitals participating in a statewide effort to improve safety in intensive care units (ICUs) are showing major improvements in the reduction of ventilator-associated pneumonias (VAPs) and catheter-related blood stream infections (CR-BSIs). Five hospitals achieved zero VAP episodes and ten hospitals achieved zero episodes of CR-BSIs. MPSC is jointly run by the Maryland Hospital Association and the Delmarva Foundation, the QIO for Maryland and the District of Columbia. The MPSC’s ICU Safety Collaborative includes ICU teams from 37 hospitals that have implemented best practices to improve care in their intensive care units. The purpose of the ICU Safety Collaborative, launched in November 2004, is to bring together multidisciplinary hospital teams and national improvement experts to achieve rapid and dramatic improvements in patient lives. Hospital multidisciplinary teams attend three one-day workshops throughout the course of the Collaborative. Between workshops, teams test changes in their local environment and share results with other participants through e-methods and conference calls. For more information, contact Kristine George at georgek@dfmc.org. Back to top AMA to Develop Quality Measures for Physicians The American Medical Association (AMA) has agreed to work with Congress to develop more than 100 standard quality of care measures that physicians will use to report to the government, reports The New York Times. The February 21 article says that “The performance measures are supposed to focus on diagnostic tests and treatments that are known to produce better outcomes for patients — longer lives, improved quality of life and fewer complications.” The agreement between Duane Cady, MD, chairman of the AMA, Senator Charles Grassley (R-IA), and Representatives Bill Thomas (R-CA) and Nathan Deal (R-GA) was dated December 16. The AMA said the pact was made in an effort to coordinate measures that the federal government will use as a basis for pay-for-performance initiatives through Medicare. Without this effort, the AMA said, physicians could be dealing with dozens of disparate measures from insurance companies and health plans as well as the government. According to the Times, the agreement calls for about 140 performance measures in 34 clinical areas to be developed by the end of this year and physicians to begin voluntarily reporting in 2007. The goal is to develop performance measures for the majority of Medicare services by the end of 2007. Media reports suggest that the Alliance of Specialty Medicine, which represents 13 national medical specialty societies, expressed concern that it was not informed of the AMA’s action until earlier this month. Leaders of the Alliance fear that the timetable set forth in the agreement may be too ambitious. Dr. Stuart L. Weinstein, a University of Iowa professor and president of the American Academy of Orthopaedic Surgeons told the Times that “Performance measures need to be developed by specialty societies, then tested and validated, to confirm that they really affect patient care in a positive way.” Back to top CMS Offers MDs Free Software to View and Print HIPAA 835s The Centers for Medicare & Medicaid Services (CMS) has announced that free software, Medicare Remit Easy Print (MREP), is available to help physicians and suppliers view and print HIPAA-compliant 835s from their own computer. Developed by CMS, this new software allows physicians and suppliers to: View, search, and print remittance information Print and export reports of Denied, Adjusted and Deductible Service Lines Print remittance information for individual or multiple selected claims, which allows physicians/suppliers to forward only those claims that are needed by other payers for secondary/tertiary payment. Find a claim based on customized search criteria, including health insurance claim number, procedure code, rendering provider number. Receive updates to Claim Adjustment Reason Codes and Remittance Advice Remark Codes three times a year. Eliminate physical filing and storage space needs. Remittance advices printed from the MREP software mirror the current Standard Paper Remittance Advice format. Before using the MREP software, physicians and suppliers must have access to HIPAA 835 files. To learn more about the software and how to receive the HIPAA 835, physicians and suppliers should contact their Medicare carrier or DMERC. Medicare Part B Electronic Data Interchange (EDI) Helpline phone numbers are available at http://www.cms.hhs.gov/ElectronicBillingEDITrans/ on the CMS website. A Special Edition Medlearn Matters article (SE0611) is available for physicians at: http://www.cms.hhs.gov/MedlearnMattersArticles/downloads/SE0611.pdf. Medlearn Matters is a series of publications that help providers understand new or changed Medicare policy. Back to top Study Compares Errors in CPOE/non-CPOE Facilities In a study published in the February 15 issue of the American Journal of Health-System Pharmacy, Agency for Healthcare Research and Quality (AHRQ) researchers using a national voluntary medication error-reporting database found that facilities with Computerized Prescriber Order Entry (CPOE) systems in place had fewer hospital-based errors and more outpatient errors than facilities without a CPOE system. The researchers also found that the most common CPOE errors were dosing errors and that using CPOE itself could lead to errors because of faulty computer interface, lack of interoperability, lack of adequate decision support, as well as human factors like typing errors, distractions, inexperience or lack of knowledge. Though it may be used effectively to determine the types of errors related to CPOE, a national voluntary medication error-reporting database, the authors conclude, “cannot be used to determine the effectiveness of a CPOE system in reducing medication errors because of the variability in the number of reports from different institutions.” Read the abstract at: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16452521&query_ hl=2&itool=pubmed_docsum Back to top Survey IDs Barriers/Keys to EHR Adoption in Hospitals In a January survey by the Healthcare Financial Management Association (HFMA), hospital and health system finance executives identify barriers and key actions to fostering adoption of electronic health records (EHRs). The top two barriers to EHR adoption: lack of national standards/code sets (62%) and funding (59%). Physician usage (51%) and lack of interoperability (50%) were also noted as significant barriers. Executives were less concerned about insufficient return on investment (28%). In roundtable discussions, health executives noted that “hospitals are determined to implement EHR systems, but that government action in the areas of standard-setting and financial support would significantly speed adoption.” The executives said government can support implementation by taking action to: Facilitate development of national standards and code sets Provide grant funding Provide payment incentives Simplify the Medicare payment system Accelerate investment in regional networks The leading strategies hospitals are employing to implement EHRs at this time include: Participation in regional information networks Participation with vendors to explore connectivity and financing solutions Collaboration with other health care organizations to control costs Identification of physician champions Providing physicians with electronic access to information that they need most Read the report at: http://www.hfma.org/EHR.pdf Back to top Study of EHR Adoption Process Reveals Barriers, Lessons A recent study in the British Medical Journal by J. Tim Scott, a Commonwealth Fund Harkness Fellow, reports on interviews with Kaiser Permanente health plan staff members in the midst of an EHR implementation to identify lessons learned. In “Kaiser Permanente’s Experience of Implementing an Electronic Medical Record: A Qualitative Study,” Scott also assessed the impact of organizational culture and leadership as well as the impact on clinical practice and patient care. The results show that perceptions of the system selection, early testing, adaptation of the system to the larger organization, and adaptation of the organization to a new electronic environment are critical to EHR adoption. Environmental factors such as leadership, culture, and professional ideals also played complex roles. Read an abstract of the article: http://bmj.bmjjournals.com/cgi/content/abstract/331/7528/1313 Back to top NQF Seeks Potential Measures for Public Reporting of Nosocomial Infections The National Quality Forum (NQF) recently announced a project to seek consensus on a set of national performance measures for public reporting of health care associated infections. NQF is now soliciting measures for review, evaluation, and potential inclusion in the final set of voluntary national measures. All proposed measures must be submitted by mail, fax, or courier to NQF by 6:00 pm, EDT on March 17, 2006. Any organization or individual may submit measures for consideration. Measures relevant to the adult and/or pediatric population may be submitted across health care settings related to the following areas: intravascular catheters and bloodstream infections; surgically implanted devices; indwelling catheters and urinary tract infections; respiratory infections, including those associated with ventilators; gastrointestinal infections; and surgical site infections. Measures will be considered at any level of analysis, including: individual physician, physician office, physician group, health care institution including but not limited to hospital and nursing home, health plan, and community- or population- level measures. To be included as part of the initial evaluation, proposed measures must be fully developed for use (e.g., research and testing have been completed) and must be applicable to health care-associated infections. Contact Sabrina Zadrozny at 202.783.1300 or szadrozny@qualityforum.org for more details. Back to top Comments Requested on Dementia Care Standards New standards for dementia care programs in nursing homes, assisted living and adult day care facilities, or other elder care services, will are available for field review. Comments on the 24 new standards, developed by the Aging Division of the Commission on the Accreditation of Rehabilitation Facilities (CARF) in accord with an International Advisory Committee of experts in the field, will be accepted until April 5th. The new standards are available on the CARF website: www.carf.org. On the homepage, click on “Field Reviews,” then scroll down and click on “Dementia.” Viewers have the ability to revisit the site as often as needed to complete the review. For more information, contact Mary Tellis-Nayak, MSN, MPH, at 202-587-5001 x5002 or mtn@carf.org. Back to top PBS Documentary Shows Nursing Home Transformation On April 4, PBS will air Almost Home, a documentary of a visionary nursing home director dedicated to transforming his institutional facility into an individualized home environment. The film by Brad Lichtenstein and Lisa Gildhaus tells the stories of couples who must juggle care for their children and for parents facing dementia and disability. It will be shown as a part of the Independent Lens series and viewers should check local listings for times. For more information about the film visit: www.almosthomedoc.org. Back to top

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