Quality Update for June 22, 2006

AMA Passes Resolution to Support Medical Review Staying with QIOs 100,000 Lives Campaign Surpasses Goals, Sets New Target New Coalition Aims to Accelerate Improvements in Hospital Heart Care Remaking American Medicine Airdates Scheduled by PBS Report Offers Lessons Learned from KatrinaHealth; Website Recognized by APhA Foundation AMA Passes Resolution to Support Medical Review Staying with QIOs At a recent meeting of the American Medical Association’s (AMA) House of Delegates, the physician organization passed a resolution to support continuation of medical review by state-based QIOs. In passing the resolution, the AMA’s House of Delegates took another path than that proposed in a recent Institute of Medicine (IOM) report, calling for regional or national contractors to take over Medicare medical review responsibilities. The IOM report stated that the current QIO tasks of quality improvement and medical case review are not compatible. The IOM recommended that Congress authorize contracts with regional or national organizations, which might include QIOs, to do this work. IOM also recommended expanding the quality improvement work of QIOs. The AMA resolution, which was brought to the House of Delegates by both the New Mexico and Wyoming delegations, noted that Western states are geographically large and culturally diverse, which makes medical review by local physicians “critically important to the appropriate rendering of peer review.” Under the current QIO medical review system the AMA said, “the potential to improve quality of care is enhanced” because review is being conducted by “the organization charged by the Centers for Medicare & Medicaid Services with helping to improve systems of care in each state.” The AMA contends that the medical review functions of QIOs are already sufficiently independent from other QIO activities. The current system works for two reasons, they said: “the peer reviewing is blinded to the economic issues related to the QIO organization,” and “the peers’ decision is final and cannot be altered by QIO staff.” Specifically, the House of Delegates resolved to: “Advocate that the medical review duties currently included in the Medicare QIO scope of work continue to remain the responsibility of the federally designated QIO in each state through the end of the current Eighth Scope of Work on into the Ninth Scope of Work and beyond.” “Advocate that medical review of physicians continue to be performed by physicians taking into account both cultural competency and local conditions” “Adopt policy to oppose the removal of medical review responsibilities from the QIO scope of work and further oppose conversion of contracts to national or regional contractors.” Back to top 100,000 Lives Campaign Surpasses Goals, Sets New Target Berwick Praises QIO Nodes On June 14, at 8 a.m. Eastern, before hundreds of attendees in a plenary address at the International Summit on Redesigning Hospital Care in Atlanta, Georgia, Don Berwick, MD, MPP, President and CEO of the Institute for Healthcare Improvement declared victory in the 100,000 Lives Campaign. The more than 3,000 participating hospitals prevented an estimated 122, 342 lives – far surpassing the Campaign’s goal of saving 100,000 lives in 18 months.   Read the new AHQA fact sheet, “What Health Care Leaders Say about QIOs,” available on the AHQA website at: http://www.ahqa.org/pub/189_1085_5234.cfm In addition to preventing unnecessary deaths, hospitals have also “proven that it’s possible for the health care community to come together voluntarily to rapidly make significant changes in patient care,” said Dr. Berwick. When the Campaign was announced in December 2004, Dr. Berwick set three objectives: save 100,000 lives, enroll more than 2,000 hospitals, and create a reusable national infrastructure for change. “Exceeding any one of those goals would have been a genuine triumph,” said David Schulke, AHQA Executive Vice President. “But I think an even more lasting effect may arise from IHI’s experience that the QIOs are an existing, reusable national infrastructure for change, and that we play well with others in a field where everyone wants to be seen as a leader.” The “national infrastructure for change” built during the Campaign extends beyond the QIOs, into a multi-tiered “node” network -- an unprecedented national effort that supports and mentors participating hospitals to institute changes that will continue to save lives. “This vibrant infrastructure is not going away – in fact, together we fully intend to build upon it in order to completely transform the health care system,” said Joe McCannon, 100,000 Lives Campaign Manager. Thirty-three QIOs are leading geographic nodes in their state while others are playing supporting roles in nodes headed by another health care leader in their community. In recognizing the Campaign’s supporters and their contributions, Dr. Berwick singled-out QIOs for their involvement – particularly those serving as geographic nodes. “Most especially, I must say, the Quality Improvement Organizations – 30 of them are helping to lead the Campaign – places like Delmarva, Qualis, and Colorado Foundation for Medical Care – all encouraged by AHQA, their association, and all have given very generously of their technical expertise from the very start,” he said. “The QIO work under their current contract with Medicare overlaps significantly with these six changes and they will be working hand in hand with hospitals and as Campaign nodes to make sure this new goal is reached,” said Schulke in a public statement about the IHI event. He told AHQA Matters, “Maybe Medicare and other leaders will come to agreement that the evidence supports making all of these topics part of the 9th Statement of Work, so more resources can be put into moving these measures in every state.” The lives saved were unnecessary deaths caused by unrecognized patient deterioration, sub-standard care for acute myocardial infarction, medication errors, central line and surgical site infections, and ventilator-associated pneumonias. IHI set out to get hospitals to voluntarily implement interventions proven to reduce mortality in one of more of these six areas. More than 3000 hospitals, representing more than 80% of all discharges across the nation, joined the Campaign. Participating hospitals were required to report baseline and follow-up data to IHI – 86% of hospitals have complied. So far, 25 facilities reported having no ventilator-associated pneumonias for a year, more than 10 had no central line infections for a year, and hundreds of hospitals instituted rapid response teams to promptly detect and treat patient deterioration. According to IHI’s calculations, these and other improvements helped save the lives of more than 122,000 individuals who would otherwise have died in a medical system fraught with preventable errors. What’s next? The Campaign is now focusing on sustaining the momentum for change and viability of its node network while accelerating the spread of health care quality improvement efforts. During his plenary address, Dr. Berwick set a new goal – “six by seven” – to get all of the more than 3000 hospitals participating in the Campaign to implement all six quality improvement changes by January 1, 2007. IHI expects to announce plans at its National Forum in December for the next stage of this health care improvement revolution. Back to top New Coalition Aims to Accelerate Improvements in Hospital Heart Care National health care leaders, including Centers for Medicare & Medicaid Services (CMS) Administrator Mark McClellan, MD, PhD, and Agency for Healthcare Research and Quality (AHRQ) Director Carolyn Clancy, MD, recently announced a new coalition to improve heart care. Members of the Alliance for Cardiac Excellence (ACE) will work together to bridge the gap between the nationally accepted standards of care and the actual care many adult cardiac patients currently receive. For instance, 85% of eligible heart attack and heart failure patients currently receive care meeting national standards – ACE members plan to ensure that 95% of all hospitals provide such care by the end of this year. ACE members will initially focus on ensuring that hospitals provide care that meets seven of the National Quality Foundation (NQF) cardiac care quality measures. By the end of 2007, the goal is to ensure that those hospitals provide care meeting the full set of 12 NQF cardiac care quality measures. ACE members plan to begin reporting on the progress of hospitals by June 30. “Today 29 national health care organizations acknowledged that one in seven Medicare beneficiaries are not being treated with proven therapies for life-threatening heart attacks and heart failure. As a founding member of this coalition, AHQA welcomes the attention this new alliance will bring to address this problem.” said David Schulke, AHQA Executive Vice President. “QIOs support the goals of ACE, including the transparency and accountability that public reporting brings,” Schulke continued. Under the 8th Scope of Work, QIOs are already providing hands-on assistance to help hospitals adopt best practices and report on the full set of 12 NQF cardiac care quality measures. Medicare funding shortfalls limit how many hospitals QIOs can help, but the ACE initiative is likely to mobilize private resources to improve quality performance. In comments during the press briefing, Administrator McClellan, told reporters that the agency was “very pleased to be a member of ACE” and that the coalition was an important part of the agency’s overall vision for quality. But even as the biggest health care influence in the nation, McClellan said, “we can’t get to better care for our patients alone.” Most of CMS’ actions in ACE would be through the QIOs, which will provide direct technical assistance and increased coordination to make sure that every hospital gets a chance to improve. A handful of other ACE members already have resources to help hospitals improve heart attack and heart failure care. For instance, the American College of Cardiology (ACC) has developed clinical practice guidelines and national cardiac registries that have been implemented in Michigan and Virginia, with results recently published in peer reviewed journal articles; many QIOs are working with the American Heart Association’s Get With The Guidelines program that helps hospitals adopt accepted standards of cardiac care; and the Institute for Healthcare Improvement (IHI) provides support and resources to help hospitals improve heart care through the 100,000 Lives Campaign. Other ACE members with existing programs include the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), Premier, and VHA Inc. Twenty-nine health care organizations are members of the ACE coalition, including AHQA and two members – the Delmarva Foundation for Medical Care, the Medicare QIO for Maryland and District of Columbia, and Louisiana Health Care Review, Louisiana’s Medicare QIO. Other members include: the American Association of Critical-Care Nurses, the American Board of Internal Medicine, the American College of Chest Physicians, the American College of Emergency Physicians, the American Hospital Association, the American Society of Echocardiography, the American Society of Health-System Pharmacists, the American Society of Nuclear Cardiology, the Centers for Disease Control and Prevention, the Disease Management Association of America, the Heart Failure Society of America, the Heart Rhythm Society, Intermountain Healthcare, the National Council on Patient Information and Education, the Society for Cardiovascular Angiography and Interventions, the Society for Geriatric Cardiology, and the Society of Hospital Medicine. Members of the coalition will work together to help hospitals improve heart care by: Communicating common messages about the appropriate care for heart attack and heart failure patients. Supporting public reporting of compliance with nationally accepted standards of care. Identifying hospitals not successfully engaged in quality improvement programs for targeted assistance unique to their facilities. Developing tools and programs based on the most current findings in cardiovascular science. Working to develop new goals that improve cardiovascular patient outcomes. Addressing barriers, such as regulatory, payment or other policies that may impede improved patient outcomes. Sharing successful strategies resulting in improved performance and patient care. AHQA is a founding member of the coalition. Other founding members include: AHRQ, ACC, American Heart Association, CMS, IHI, JCAHO, the National Committee for Quality Assurance, Premier, Inc., and VHA Inc. Back to top Remaking American Medicine Airdates Scheduled by PBS Airdates are confirmed for the PBS series “Remaking American Medicine … Health Care for the 21st Century.” The series will be broadcast nationally every Thursday evening in October, beginning October 5 through the 26.   RAM Campaign Dates to Remember September 27 National Symposium Washington , DC October 5 Silent Killer October 12 First Do No Harm October 19 The Stealth Epidemic October 26 Hand in Hand For more information: RAMCampaign.org More than 27 RAM coalitions, many lead by QIOs, have been working in communities across the country to host programs and develop resources leading up to this national event. Each coalition is a unique blend of diverse stakeholders including local public and private partnerships spanning the range of health care, as well as media, consumer, and business. A National Symposium is scheduled for September 27, 2006 at the Henry J. Kaiser Family Foundation offices in Washington, D.C., just prior to the first airdate. Donald Berwick, MD, MPP, president and CEO of the Institute for Healthcare Improvement (IHI), will serve as the keynote speaker; John Hockenberry, will serve as host (Hockenberry also hosts the series). Other nationally recognized individuals and a number of Champions of Change who appear in the series will also be on hand. The Amgen Foundation is underwriting the National Symposium, with funding facilitated by the American Health Quality Foundation, which served as fiscal agent. The Symposium will be broadcast live via the web. Silent Killer - October 5 This program begins by profiling the efforts of Sorrel King, whose 18-month-old daughter Josie was killed at one of the most respected hospitals in the world, Johns Hopkins. King’s journey from grieving victim to engaged activist led her to partner with Johns Hopkins to make safety a top priority at the institution. She also works with Dr. Berwick and the 100,000 Lives Campaign. First Do No Harm - October 12 Physicians at two hospitals are challenging their colleagues to First Do No Harm. In Pittsburgh, Pennsylvania, Chief of Medicine Dr. Richard Shannon is confronting an epidemic of hospital-acquired infections while Hackensack University Medical Center in New Jersey is engaged in an effort to totally transform the way the institution delivers care. The Stealth Epidemic - October 19 Two very different communities -- Los Angeles, Calif. and Whatcom County, Washington -- are addressing the need to improve care for chronic diseases like diabetes and heart failure by fundamentally transforming the physician-patient relationship. Hand in Hand - October 26 The final program addresses the changing relationship between providers, patients, and families. It tells the story of patients and families who have formed a unique bond in a teaching hospital in the small town of Augusta, Georgia to transform the institution into a nationally recognized facility where partnership is a guiding vision to the care it delivers. Back to top Report Offers Lessons Learned from KatrinaHealth; Website Recognized by APhA Foundation AHQA and Louisiana QIO Contributed to Effort In a new report the Markle Foundation outlines lessons learned in posting secure, online information about the prescription drug histories of Katrina evacuees in the aftermath Hurricanes Katrina and Rita, which devastated the Gulf Coast last summer. The report, “Lessons from KatrinaHealth,” was produced by a group of industry and government experts convened to glean lessons from the experiences of health care professionals and patients following the disaster. It includes key insights such as the need to: Foster immediate discussions regionally and nationally among government health leaders, insurers, health care providers, and information technology companies to determine what, how, and when patient medical information can be shared securely and quickly in the event of a disaster. Create electronic health information systems that are based on simple, open web standards, so that data can be provided in different formats from different users and still be accessible to all. Agree upon a method to authenticate the identities of doctors, pharmacists, other health professionals, and patients using the web site, so that they can quickly and securely access private health information needed for their ongoing treatment. Make electronic health information records accessible to nurse practitioners, physician assistants, and nurses who will likely be working with physicians and clinics in a disaster’s aftermath, rather than just by physicians. Examine federal and state policies governing privacy and medical records -- such as the Health Insurance Portability and Accountability Act and existing state privacy laws -- to be sure they do not hinder the delivery of medical care for displaced persons post-disaster. In less than three weeks following Hurricane Katrina’s landfall, a group of private and public health and information technology experts created http://www.KatrinaHealth.org, an online service for authorized health professionals. The web site provided authorized users access to evacuees’ medication information in order to renew prescriptions, prescribe new medications, and coordinate care. More than 150 organizations participated in the planning, testing, launching, and facilitation of KatrinaHealth.org, including AHQA, Louisiana Health Care Review (LHCR), the state’s QIO, the American Medical Association, Gold Standard, the Louisiana and Mississippi Departments of Health, RxHub, the Office of the National Coordinator for Health Information Technology, SureScripts, and United States Department of Veterans Affairs. “Everyone should make sure they have this information, but it is especially critical for people with chronic and life- threatening conditions,” Michael D. Maves, MD, chief executive officer and executive vice president of the American Medical Association. For a full copy of the Lessons from KatrinaHealth report, log onto http://www.markle.org. Back to top Pinnacle Award KatrinaHealth.org received a Pinnacle Award from the American Pharmacists Association Foundation’s Quality Center. Established in 1998, the Pinnacle Award is given to organizations or individuals “for a significant scientific contribution and/or exemplary leadership in the improvement of quality in the medication use process and the delivery of appropriate pharmaceutical care.” Several organizations, including the American Medical Association, Informed Decisions LLC, Markle Foundation, SureScripts, and the United States Department of Veterans Affairs, were recognized for their leadership of the KatrinaHealth program. Both AHQA and LHCR were recognized as contributing to this effort. “The expansion of the program to include all hurricane evacuees from Mississippi and Louisiana required an unprecedented collaboration of private companies, public agencies, and national organizations,” the award announcement said. “Many players worked together to ensure the most comprehensive prescription history information possible was available for the more than one million impacted lives.” Back to top

Home :: Inside AHQA :: For The Media :: Public Policy :: Advancing Quality :: Quality Connections :: SiteMap