Tuesday, May 31, 2005

Health Technol Assess - The investigation and analysis of critical incidents and adverse events in healthcare

Woloshynowych M, Rogers S, Taylor-Adams S, Vincent C.
Health Technol Assess. 2005 May;9(19):1-158.


NQF - Endorses HCAHPS Survey


HCAHPS® is a 27-item survey designed and developed over a three year period by the Centers for Medicare & Medicaid Services and the Agency for Healthcare Research and Quality.

The primary purpose of the survey is to provide standardized information across institutions and over time about how patients experience hospital care. Results from the survey are intended for public reporting.


Monday, May 30, 2005

CMWF - Five Years After To Err is Human

The Commonwealth Fund Quality Improvement Colloquium marked the fifth anniversary of the U.S. Institute of Medicine's seminal report, To Err is Human, with a special expert forum.


AHRQ - Beta-Blockers for Acute Myocardial Infarction

AHRQ has joined several other organizations in issuing a practice advisory and fact sheet in response to early results from the COMMIT/CCS-2 trial on the use of beta blockers within 24 hours of when patients arrive at the hospital with a heart attack.

The advisory and fact sheet caution that since all of the details on the methodology and results of the trial are not yet available, it is too soon to determine whether changes are called for in the current measures and guidelines for those patients.

AHRQ - Questions and Answers: Beta-Blockers for Acute Myocardial Infarction.
April 27, 2005.

Saturday, May 28, 2005

Friday, May 27, 2005

AHRQ - Guidance for Using the AHRQ Quality Indicators

for Hospital-level Public Reporting or Payment

The perceived advantage of the QIs is that they measure outcomes that consumers care about; these indicators also use administrative data, which are relatively inexpensive, readily available, and already used for hospital quality improvement.

Because AHRQ originally developed and refined these indicators for use in quality improvement and national tracking, there has been some question about how and if to use them in these new ways. The purpose of this document is to provide guidance on this question.

Summary of Hospital Public Reporting Websites

The State-of-the-Art of Online Hospital Public Reporting: A Review of Forty-Seven Websites

Delmarva Foundation and Joint Commission on Accreditation of Healthcare Organizations September 2004

Review of Hospital Quality Reports for Health Care Consumers, Purchasers and Providers

IPRO 2003

Thursday, May 26, 2005

CMWF - Quality of Health Care for Medicare Beneficiaries

A Chartbook assess the quality of care provided to millions of elderly and disabled Medicare beneficiaries
Sheila Leatherman and Douglas McCarthy,
The Commonwealth Fund, May 2005

For a complete list of Commonwealth Fund chartbooks and chartpacks, click here

IHI - Seven Leadership Leverage Points for Organizational Improvement

Reinertsen JL, Pugh MD, Bisognano M
Institute for Healthcare Improvement; 2005

As part of its ongoing work supporting and encouraging health care leaders who are committed to making improvement a unifying strategy, IHI is proud to offer a new Innovation Series white paper detailing seven "Leadership Leverage Points" for achieving dramatic, system-level performance improvement. The paper is free and available on www.ihi.org/IHI/...

Wednesday, May 25, 2005

BMJ - Improving clinical practice using clinical decision support systems

a systematic review of trials to identify features critical to success
Kawamoto K, Houlihan CA, Balas EA, Lobach DF.
BMJ. 2005 Apr 2;330(7494):765


AHRQ - Emergency Severity Index, Version 4

The Emergency Severity Index (ESI) is a five-level emergency department (ED) triage algorithm that provides clinically relevant stratification of patients into five groups from 1 (most urgent) to 5 (least urgent) on the basis of acuity and resource needs.
The Agency for Healthcare Research and Quality (AHRQ) funded initial work on the ESI.


Tuesday, May 24, 2005

Int J Quality in Health Care - A systematic review of appraisal tools for clinical practice guidelines

multiple similarities and one common deficit
International Journal for Quality in Health Care 2005 17(3):235-242
Joan Vlayen, Bert Aertgeerts, Karin Hannes, Walter Sermeus and Dirk Ramaekers


CMWF - Quality Improvement Colloquium

Patient Safety Five Years After To Err is Human

The Commonwealth Fund Quality Improvement Colloquium marked the fifth anniversary of the U.S. Institute of Medicine's seminal report, To Err is Human, with a special expert forum.


Monday, May 23, 2005

CMWF - Measure, Learn, and Improve

Physicians' Involvement in Quality Improvement
Payers, accreditors, and consumers are using quality improvement (QI) methods, but there is still one key group for whom the pursuit of QI has not become routine: physicians.

Marie J. Audet, M.D., Michelle M. Doty, M.P.H., Ph.D., Jamil Shamasdin, and Stephen C. Schoenbaum, M.D., M.P.H.,
Health Affairs May/June 2005 24 (3) 843-53

Many US doctors do not want to share performance data with patients
BMJ - News roundup

BMJ - Hospital indicators of poor sexual health

Dr Foster's case notes
BMJ 2005;330:1173 (21 May)


Friday, May 20, 2005

JAMA - Five Years After To Err Is Human

What Have We Learned?
Lucian L. Leape, MD; Donald M. Berwick, MD
JAMA. 2005;293:2384-2390.


Ontario - Hospital Report Project


The Hospital Report Research Collaborative is an independent Research Collaborative whose mandate is to conduct research and engage Ontario hospitals in performance measurement and management activities.

The Research Collaborative has developed methods and reports on hospital performance in Ontario using the balanced scorecard format resulting in one of the most comprehensive sets of performance measurement reports internationally.

Hospital Report: Acute Care 2003

Quality Improvement (QI) Tools:

WHIC Tool (Wizard for Hospital Indicator Calculation)www.hospitalreport.ca/WHIC_Tool.html

Chart Audit Tool

Thursday, May 19, 2005

OECD - Health Care Quality Indicators Project


HCQI builds on the efforts of several OECD countries and two international collaborations in developing indicators of health care quality at the national level.

During 2004 the project was in the process of collecting preliminary data, and examining its international comparability, for an initial set of 17 indicators. It is hoped that a research report will be published in 2005.

5 technical papers were released containing the recommendations of 5 Expert Panels, respectively, on additional indicators in 5 priority areas.

No. 18 Selecting Indicators for Patient Safety at the Health Systems Level in OECD Countries
John Millar, Soeren Mattke and the Members of the OECD Patient Safety Panel

No. 17 Selecting Indicators for the Quality of Mental Health Care at the Health Systems Level in OECD Countries
Richard Hermann, Soeren Mattke and the Members of the OECD Mental Health Care Panel

No. 16 Selecting Indicators for the Quality of Health Promotion, Prevention and Primary Care at the Health Systems Level in OECD Countries
Martin Marshall, Sheila Leatherman, Soeren Mattke and the Members of the OECD Health Promotion, Prevention and Primary Care Panel

No. 15 Selecting Indicators for the Quality of DiabetesCare at the Health Systems Level in OECD Countries
Sheldon Greenfield, Antonio Nicolucci and Soeren Mattke

No. 14 Selecting Indicators for the Quality of Cardiac Care at the Health Systems Level in OECD Countries
Laura Lambie, Soeren Mattke and the Members of the OECD Cardiac Care Panel

The Commonwealth Fund - International Working Group on Quality Indicators

First Report and Recommendations of the Commonwealth Fund's International Working Group on Quality Indicators
The Commonwealth Fund, June 2004

The first report to the health ministers of Australia, Canada, New Zealand, the United Kingdom, and the United States provides detailed data on 40 key health care quality indicators, which the Working Group developed to help benchmark and compare health care system performance across the five countries.

Wednesday, May 18, 2005

WHO - Hospital performance


The objective of the project is to support hospitals in assessing their performance, questioning their own results, and translating them into actions for quality improvement.

This is done by providing hospitals with integrated tools for performance assessment and by enabling collegial support and networking among them.

Performance assessment will be designed for internal use and on a voluntary basis. It does not aim at external reporting or at being used by any local or national agency for restructuring purpose.

A Performance Assessment Tool for quality improvement in Hospitals (PATH) has been developed to support hospitals in improving their performance.
It is presently (2004) being piloted in 67 hospitals in Belgium, Denmark, France, Lithuania, Poland (Silesia region), Slovakia, South Africa (Kwazulu-Natal) and Canada (Ontario).

Selection of indicators for hospital measurement performance

Pilot implementation of PATH

Tuesday, May 17, 2005

Ann Intern Med - Understanding Rising Health Care Costs

Introducing a Series of Articles
Sox, H. C.
Ann Intern Med 2005 142: 865

The cost of health care is one of the most serious problems facing the United States. Many factors drive health care costs, and their interrelationships are so complex that most people, whether in the health care field or not, do not understand them. Since understanding a problem is an essential step toward solving it, Annals will publish a series of 4 articles on health care costs intended as a touchstone for physicians and the public.

The first of these articles:

High and Rising Health Care Costs.
Part 1: Seeking an Explanation
Bodenheimer T.
Ann Intern Med 2005 142: 847-854

Monday, May 16, 2005

CMS - pay-for-performance


The CMS/Premier Hospital Quality Incentive (HQI) Demonstration Project tracks hospital performance on a set of 34 nationally standardized and widely accepted quality indicators and pays annual incentives to top performers among participating hospitals.

With four quarters of preliminary data gathered, there is a clear trend toward significantly improved quality among the participating hospitals.

HealthGrades - Patient Safety in American Hospitals Study


To identify the patient safety incident rates for every hospital in the country, HealthGrades applied AHRQ’s Patient Safety Indicator methodology1 to three years of Medicare data (2001-2003).

The second annual HealthGrades Patient Safety in American Hospitals Study finds that 1.18 million patient safety incidents occurred among Medicare hospitalizations in the years 2001, 2002 and 2003, with the cost to Medicare approaching $3 billion annually. That compares with 1.14 million incidents in the three years beginning with 2000.

California - Report on Coronary Artery Bypass Graft Surgery

2000-2002 Hospital Data

This third report from the California CABG Mortality Reporting Program (CCMRP) presents findings from analyses of data collected from 77 of California's 121 hospitals that regularly performed CABG surgery and uses in-hospital mortality as the key outcome measure.

This third and final report provides a comprehensive description of the program, including the methodologies used, the risk model, and detailed statistical results and data summaries for the 77 participating hospitals.

The 2000-2002 report tracks 73 percent of coronary artery bypass surgeries performed in California’s hospitals and confirms findings from previous reports - volunteer hospitals are the better performing hospitals and hospitals with a higher volume of surgeries (greater than 200 per year) tend to have better outcomes.

The results indicate that although not all low volume hospitals have poor performance, there is a clear relationship between high volume and lower mortality.

Sunday, May 15, 2005

BMJ - Dr Foster's case notes

BMJ monthly page highlighting data from Dr Foster (http://www.drfoster.co.uk/), an independent London based organisation that analyses the availability, quality, and costs of health care in the United Kingdom and globally.

BMJ aim to provide doctors, managers, and patients with data about how various treatments and systems work in the real, messy world of clinical practice.

Dr Foster uses administrative data such as hospital episodes statistics and self reported data collected from hospitals by survey.


Ann Intern Med: Improving Patient Care

Improving Patient Care is a special section within Annals supported in part by the U.S. Department of Health and Human Services (HHS) Agency for Healthcare Research and Quality (AHRQ).
Recent Selected Abstracts:


Implantable Cardioverter Defibrillators: An Excellent Case Study

Evidence-Based Medicine And Policy: The Case Of The Implantable Cardioverter Defibrillator Mark A. Hlatky, Gillian D. Sanders, and Douglas K. Owens Health Aff (Millwood). 2005 Jan-Feb;24(1):42-51

Implantable Cardioverter Defibrillators: An Excellent Case Study
Marshall S. Stanton Health Aff (Millwood). 2005 Jan-Feb;24(1):52-4.

Clinical and economic implications of the Multicenter Automatic Defibrillator Implantation Trial-II.
Al-Khatib SM, Anstrom KJ, Eisenstein EL, Peterson ED, Jollis JG, Mark DB, Li Y, O'Connor CM, Shaw LK, Califf RM.
Ann Intern Med. 2005 Apr 19;142(8):593-600

Preventing sudden cardiac death: can we afford the benefit? Editorial
Pauker SG, Estes NA, Salem DN.
Ann Intern Med. 2005 Apr 19;142(8):664-6

Friday, May 13, 2005

ASSR - Convegno indicatori

Convegno di presentazione dei risultati del progetto di ricerca finalizzata (ex-art. 12 D.Lgs 502/92)


ROMA, 26-27 MAGGIO 2005Università di Tor Vergata, via Montpellier n. 1 - Roma

Programma del convegno

BMJ - Monitoring surgical mortality

Monitoring surgical mortality - Editorial
Nancy N Baxter
BMJ 2005:1098-1099, doi:10.1136/bmj.330.7500.1098 [Extract] [Full text] [PDF]

Building a framework for trust: critical event analysis of deaths in surgical care
A M Thompson, P A Stonebridge
BMJ 2005:1139-1142, doi:10.1136/bmj.330.7500.1139 [Extract] [Full text] [PDF]

Commentary: Excellent review scheme for critical incidents but insufficient for revalidation
Mayur Lakhani
BMJ 2005:1143, doi:10.1136/bmj.330.7500.1143 [Extract] [Full text] [PDF]

GMC and the future of revalidation: Failure to act on good intentions
Aneez Esmail
BMJ 2005:1144-1147, doi:10.1136/bmj.330.7500.1144 [Extract] [Full text] [PDF]

Revalidation in the UK
Zosia Kmietowicz
BMJ 2005:1145, doi:10.1136/bmj.330.7500.1145 [Extract] [Full text] [PDF]

AHRQ - Advances in Patient Safety: From Research to Implementation

Shows Accomplishments, Challenges for Improving Patient Safety and Reducing Medical Errors

it is the first compendium of studies on the successes and challenges of efforts to improve patient safety and reduce medical errors. Advances in Patient Safety: From Research to Implementation is a four-volume set of 140 peer-reviewed articles that represents an overview of patient safety studies by AHRQ-funded researchers and other government-sponsored research.

The four volumes contain information on virtually every dimension of the patient safety field, including new research findings on medication safety, technology, investigative approaches to better treatment, process analyses, human factors, and practical tools for preventing medical errors and harm.

The compendium features emerging lessons from clinical studies, presents cutting-edge technologies such as simulation tools for surgery training, the effects of change on dynamic systems of care, and national and regulatory issues.

AHRQ - Patient Safety Network (PSNet)


a new web-based resource featuring the latest news and essential resources on patient safety. The site offers weekly updates of patient safety literature, news, tools, and meetings (“What’s New”), and a vast set of carefully annotated links to important research and other information on patient safety (“The Collection”). Supported by a robust patient safety taxonomy and web architecture, AHRQ PSNet provides powerful searching and browsing capability, as well as the ability for diverse users to customize the site around their interests (My PSNet). It also is tightly coupled with AHRQ WebM&M, the popular monthly journal that features user-submitted cases of medical errors, expert commentaries, and perspectives on patient safety.

Am J Manag Care - Veterans Administration

The American Journal Of Managed Care. November 2004 - Part 2

issue dedicated to highlight health services research performed in the VA system.

Regence Group - Measuring Provider Efficiency


Until now, there lacked a systematic, empirically informed and consensus-based process to understand how best to measure cost efficiency. The need for valid, reliable, and actionable information on provider efficiency remains very high. The goal of this White Paper is to launch an ongoing process that will provide guidance to all stakeholders based on available knowledge about efficiency measurement. These recommendations are not intended to represent the “last word” on provider efficiency, rather, they are intended to create a framework that is sound enough to use as a basis for measurement today, and to act as a catalyst for stimulating the evolution of measurement as our knowledge and understanding of this field grows. To that end, an online learning community has been established at www.regence.com/research to facilitate the continued sharing of knowledge.

NQF - Hospital Governing Boards and Quality of Care

A Call to Responsibility

It is well established that a hospital’s board of trustees has responsibility for the quality of clinical care provided in the institution(s) it governs. As follow-up to a March 2004 meeting, a "Call to Responsibility" was developed that calls on hospital governing boards to review their policies and practices to make sure that they are consistent with four principles fundamental to delivering quality healthcare.

AHRQ - National Healthcare Quality Report (NHQR) and National Healthcare Disparities Report (NHDR)

The National Healthcare Quality Report (NHQR)www.qualitytools.ahrq.gov/.../browse.aspx

This is the second annual NHQR. This second report extends the baseline established in the 2003 report for a set of health care quality measures across four dimensions of quality - effectiveness, safety, timeliness, and patient centeredness - and, within the effectiveness component, nine clinical condition areas or care settings - cancer, diabetes, end stage renal disease, heart disease, HIV/AIDS, maternal and child health, mental health, respiratory diseases, and nursing home and home health care. The purpose of the report is to track the state of health care quality for the Nation on an annual basis.

The National Healthcare Disparities Report (NHDR)www.qualitytools.ahrq.gov/.../browse.aspx

Released in 2003, the first NHDR is a comprehensive national overview of disparities in health care among racial, ethnic, and socioeconomic groups in the general U.S. population and among priority populations. This second NDHR is built upon the 2003 report and continues to include a comprehensive national overview of disparities in health care in America. In addition, in the 2004 report, a second critical goal of the report is developed: tracking the Nation's progress towards the elimination of health care disparities.

STATE RESOURCES for Selected Measures from the 2004 National Healthcare Quality Report

Resources for States have been developed using data from AHRQ’s 2004 National Healthcare Quality Report. It includes State-level statistics for around 100 of these measures.

Med Care - Health Care Quality and Disparities: Lessons From the First National Reports
Medical Care. March 2005, Volume 43, Issue 3 Supplement


Health Affairs - Putting Evidence Into Practice

January/February 2005 - Volume 24, Number 1
The era of evidence-based medicine, long in gestation, has arrived in full flower as an increasing number of individuals and organizations are coming to accept its potential to improve the quality of care delivered and to make that care more affordable. Reflections of this new emphasis are apparent in many places: from newspaper editorials that promote the concept, to broader government efforts to invest more resources in producing solid evidence, to private-sector initiatives that use evidence in the search for better value.
To underscore the more aggressive pursuit of better evidence, Health Affairs is devoting this issue of the journal to EBM.

Qual Saf Health Care - Adverse drug events and medication errors

detection and classification methods
Morimoto T, Gandhi TK, Seger AC, Hsieh TC, Bates DW.
Qual Saf Health Care. 2004 Aug;13(4):306-14


Med Care - Accuracy of ICD-9-CM codes for identifying cardiovascular and stroke risk factors.

Birman-Deych E, Waterman AD, Yan Y, Nilasena DS, Radford MJ, Gage BF.
Med Care. 2005 May;43(5):480-5


J Med Libr Assoc - Development and evaluation of evidence-based nursing (EBN) filters and related databases.

Lavin MA, Krieger MM, Meyer GA, Spasser MA, Cvitan T, Reese CG, Carlson JH, Perry AG, McNary P.
J Med Libr Assoc. 2005 Jan;93(1):104-15


JAMA - Computer technology and clinical work: still waiting for Godot.

Wears RL, Berg M.
JAMA. 2005 Mar 9;293(10):1261-3


JAMA - Role of computerized physician order entry systems in facilitating medication errors.

Koppel R, Metlay JP, Cohen A, Abaluck B, Localio AR, Kimmel SE, Strom BL.
JAMA. 2005 Mar 9;293(10):1197-203.


JAMA - Relationship between low quality-of-care scores and HMOs' subsequent public disclosure of quality-of-care scores.

McCormick D, Himmelstein DU, Woolhandler S, Wolfe SM, Bor DH.
JAMA. 2002 Sep 25;288(12):1484-90


JAMA - External incentives, information technology, and organized processes to improve health care quality for patients with chronic diseases.

Casalino L, Gillies RR, Shortell SM, Schmittdiel JA, Bodenheimer T, Robinson JC, Rundall T, Oswald N, Schauffler H, Wang MC.
JAMA. 2003 Jan 22-29;289(4):434-41


JAMA - Error reporting and disclosure systems

views from hospital leaders
Weissman JS, Annas CL, Epstein AM, Schneider EC, Clarridge B, Kirle L, Gatsonis C, Feibelmann S, Ridley N.
JAMA. 2005 Mar 16;293(11):1359-66.


JAMA - Effects of computerized clinical decision support systems on practitioner performance and patient outcomes

a systematic review
Garg AX, Adhikari NK, McDonald H, Rosas-Arellano MP, Devereaux PJ, Beyene J, Sam J, Haynes RB.
JAMA. 2005 Mar 9;293(10):1223-38


JAMA - Disease management and the organization of physician practice.

Casalino LP.
JAMA. 2005 Jan 26;293(4):485-8


JAMA - The unintended consequences of publicly reporting quality information.

Werner RM, Asch DA.
JAMA. 2005 Mar 9;293(10):1239-44


AHRQ - Performance Measurement, Data Aggregation, and Reporting

To identify critical opportunities in ambulatory care performance measurement, the second in a series of meetings was held on January 17-18, 2005. The second meeting was convened to review the initial recommendations of the three workgroups (on performance measurement, data sharing and aggregation, and reporting) and to discuss how to move forward.

Where We Are and Where We Need To Go
Meeting Goals
CMS Perspective
Session on Performance Measurement
Session on Data Sharing and Aggregation
Session on Reporting
Next Steps

Thursday, May 12, 2005

JCAHO - Principles for the Construct of Pay-for-Performance Programs


In recent years, thought leaders and policy-makers have directed increased attention to strategies for achieving system-wide improvements in health care quality and patient safety that will lead to larger-scale, more rapid changes in professional and provider behavior than have been experienced to date. To achieve such extraordinary progress, they have chosen to promote and leverage experimentation in programs that offer structured incentives for practitioners and providers to achieve benchmarks of performance.

The hope is that by offering positive rewards – both for reaching thresholds of performance and for making continuous strides in improving the quality of health care – high quality health care will be delivered on a consistent basis. This approach acknowledges the reality that financial rewards are among the most powerful tools for bringing about behavior change.

Notwithstanding their recent proliferation, pay-for-performance programs are largely untested. It is important that these programs be well-designed, make every effort to encompass all affected stakeholders for whom the incentives must be aligned, and be designed and implemented in a manner that engenders, maintains, and continually promotes trust among all of the participating parties.

JCAHO - Health Care At The Crossroads

Strategies for Improving the Medical Liability System and Preventing Patient Injury
published 2/05.


The liability system supports a “wall of silence” -- discouraging disclosure and inhibiting efforts to create cultures of safety inside health care organizations and among practitioners. Creating cultures of safety within health care and improving quality and access -- indeed, making health care truly better -- requires that legal and medical institutions work together.9 In order to frame the complex factors and issues that need to be addressed in order to accomplish such alignment, the Joint Commission convened an expert Roundtable. Among the principal specific issues addressed by the Roundtable were the extent to which the current medical liability system undermines or supports patient safety, and if, indeed, it undermines patient safety, are effective remedial actions possible? Further, if the aforementioned dissonance is serious and real, what short-term steps should be taken to moderate the negative impacts of the system? And finally, what potential long-term alternatives to the current tort system should be considered and how might they best be pursued? This white paper represents a culmination of these discussions.

CHCS - Health Indicator System for Rhode Islanders on Medicaid

An Effective Model to Identify Unmet Health Care Needs andEvaluate Program Initiatives
Jane Griffin
Rhode Island Medicaid Research and Evaluation Project
April 2005


The Rhode Island Department of Human Services developed and implemented a Health Indicator System to assess, design, monitor, and evaluate health services and program interventions for Rhode Islanders on Medicaid. Health Indicators are designed from existing public health data sets (e.g., adequacy of prenatal care from Vital Statistics Birth File and infant mortality from Vital Statistics Death File), state surveys of Medicaid enrollees (e.g., Unmet Health Care Needs of both children and adults with disabilities), and the Medicaid program data (e.g., Leading causes of hospitalizations from the MMIS).
Health Indicators are analyzed by insurance status in order to compare outcomes between privately and publicly insured Rhode Islanders. Indicators are developed from reliable data sets that are collected regularly so changes in health status can be measured.
The Health Indicator System in Rhode Island is unique because the state Medicaid program has integrated this model into its program operations and uses these measures to design and evaluate its ongoing program initiatives. Health Indicator Results and Reports are presented monthly to Medicaid program directors and staff at the Evaluation Studies Workgroup. This interdisciplinary workgroup provides a forum for researchers, planners,
and program managers to discuss which health indicators reflect unmet need for Medicaid enrollees and to select health indicators to track over time.
The Rhode Island Medicaid program has tracked several health indicators for the past 10 years and these results are included in this report:
• Adequacy of prenatal care
• Maternal smoking
• Short interbirth interval
• Infant mortality
• Teen repeat birth rate
• Low income uninsured children
• Mental health hospitalizations

CMWF - Paying for Performance

Patricia Seliger Keenan, M.H.S., and Janet Kline
The Commonwealth Fund
November 2004


Studies show that current provider payment systems tend to discourage quality
improvement in the health care system. A frequently suggested solution is “paying for performance,” a reference to a range of strategies to reorient payment incentives by rewarding efforts to improve quality.

Quality problems have been documented for decades, both in fee-for-service and managed care delivery systems. Paying for performance is a relatively new approach to address longstanding quality problems, by rewarding providers for delivering care that is clinically effective and results inimproved health.

AHRQ - Publications Catalog, Spring Summer 2005


Table of Contents
Agency Information
Children's Health
Clinical Practice Guidelines
Clinical Preventive Services
Consumer Information and Education
Data Development and Use
Dental Health
Elderly/Long-term Care
Evidence-Based Medicine
Health Care Cost and Utilization
Health Care Markets/Managed Care
Health Insurance/Access to Care
Health Services Research Health Technology
Medical Informatics Minority Health
Outcomes and Effectiveness Research
Patient Safety/Medical Errors
Primary Care Quality of Care
Research Syntheses
Statistical and Methodological Research
Women's Health

Inquiry - Quality report cards, selection of cardiac surgeons, and racial disparities

a study of the publication of the New York State Cardiac Surgery Reports
Mukamel DB, Weimer DL, Zwanziger J, Gorthy SF, Mushlin AI.


J Clin Epidemiol - Conventional models overestimate the statistical significance of volume-outcome associations, compared with multilevel models

Urbach DR, Austin PC.
J Clin Epidemiol. 2005 Apr;58(4):391-400.


Med Care - Quality improvement efforts and hospital performance

rates of beta-blocker prescription after acute myocardial infarction
Bradley EH, Herrin J, Mattera JA, et al.
Med Care. 2005 Mar;43(3):282-292.


JAMA - Error reporting and disclosure systems: views from hospital leaders

Weissman JS, Annas CL, Epstein AM, Schneider EC, Clarridge B, Kirle L, Gatsonis C, Feibelmann S, Ridley N.
JAMA. 2005 Mar 16;293(11):1359-66.


Methods Inf Med - The EpiLink record linkage software

presentation and results of linkage test on cancer registry files
Contiero P, Tittarelli A, Tagliabue G, Maghini A, Fabiano S, Crosignani P, Tessandori R.
Methods Inf Med. 2005;44(1):66-71.


Stat Med - Funnel plots for comparing institutional performance

Spiegelhalter DJ
Stat Med. 2005 Apr 30;24(8):1185-202


AHRQ - Ambulatory Performance Measures "Major Step" in Improving Quality of Health Care

Broad-based Coalition Reaches Consensus on "Starter Set" for Physicians


In a major step toward improving the quality of the U.S. health care system, the Ambulatory care Quality Alliance (AQA) has selected a "starter set" of 26 clinical performance measures for the ambulatory care setting. The starter set of measures is intended to provide clinicians, consumers and purchasers with a set of quality indicators that may be utilized for quality improvement, public reporting and pay for performance programs.
The measures in the starter set will lead to a uniform set of measures for ambulatory care that can focus quality efforts and give consumers data they need to make more informed health care decisions. The starter set of measures may be incorporated into performance-based payments as early as next year.
This approach is similar to the Hospital Quality Alliance that has involved a broad array of stakeholders with the goal of producing a standardized set of measures for inpatient care. Select for background on the 26 measures proposed (PDF file, 25 KB) and for more information on the ambulatory care starter set (PDF file, 19 KB).

BMJ - Measuring NHS productivity

Berwick DM.
BMJ. 2005 Apr 30;330(7498):975-6


BMJ - What can the UK and US health systems learn from each other?

Quam L, Smith R.
BMJ. 2005 Mar 5;330(7490):530-3


BMJ - Simulation based training

Moorthy K, Vincent C, Darzi A.
BMJ. 2005 Mar 5;330(7490):493-4


BMJ - Patients' safety

Stryer D, Clancy C.
BMJ. 2005 Mar 12;330(7491):553-4


BMJ - Improving clinical practice using clinical decision support systems

a systematic review of trials to identify features critical to success.
Kawamoto K, Houlihan CA, Balas EA, Lobach DF.
BMJ. 2005 Apr 2;330(7494):765


BMJ - Was Rodney Ledward a statistical outlier?

Retrospective analysis using routine hospital data to identify gynaecologists' performance.
Harley M, Mohammed MA, Hussain S, Yates J, Almasri A.
BMJ. 2005 Apr 23;330(7497):929


OECD - Tackling Nurse Shortages In OECD Countries

OECD Health Working Papers No. 19
Steven Simoens, Mike Villeneuve and Jeremy Hurst
OECD 2005


There are reports of current nurse shortages in all but a few OECD countries. With further increases in demand for nurses expected and nurse workforce ageing predicted to reduce the supply of nurses, shortages are likely to persist or even increase in the future, unless action is taken to increase flows into and reduce flows out of the workforce or to raise the productivity of nurses.

This paper analyses shortages of nurses in OECD countries. It defines and describes evidence on current nurse shortages, and analyses international variability in nurse employment. Additionally, a number of demand and supply factors that are likely to influence the existence and extent of any future nurse shortages are examined. In order to resolve nurse shortages, the paper compares and evaluates policy levers that decision makers can use to increase flows of nurses into the workforce, reduce flows out of the workforce, and improve nurse retention rates.

CMWF - Hospital Quality: Ingredients For Success

Overview And Lessons Learned
Jack A. Meyer, Sharon Silow-Carroll, Todd Kutyla,
Larry S. Stepnick, and Lise S. Rybowski
July 2004


ABSTRACT: Hospitals across the country are searching for ways to improve quality of care and promote effective quality improvement strategies. This research study identifies and describes the key factors that contributed to the success of four high-performing hospitals across the country. Essential elements of a successful strategy, according to the study, include developing the right culture, attracting and retaining the right people, devising and updating the right in-house processes, and giving staff the right tools to do the job. External influences, such as local market competition and public or private health quality initiatives and standards, also have an impact. Through information gleaned from site visits and in-depth interviews with these high-performing hospitals, the study assesses quality drivers, internal processes, and challenges, and offers guidance and actions steps to help hospitals move in the right direction.

JCAHO - Joint Commission International Center for Patient Safety


In March 2005, the Joint Commission on Accreditation of Healthcare Organizations and Joint Commission Resources (JCR) announced the establishment of the Joint Commission International Center for Patient Safety, a virtual entity that draws upon the patient safety expertise, resources and knowledge of both the Joint Commission and JCR. The center will provide patient safety solutions to health care organizations worldwide. The mission of the center is: To continuously improve patient safety by providing solutions, processes and procedures that help eliminate preventable adverse events in all health care settings.

Recognized as a leader in patient safety, the Joint Commission promotes and provides for the delivery of safe, high-quality care through its standards, sentinel event database, Sentinel Event Alert, Speak Up™ programs and, most recently, its National Patient Safety Goals. The Patient Safety Center allows the Joint Commission and JCR to advance the entire continuum of patient safety including system design, product safety, safety of services, and environment of care, as well as offering proactive solutions for patient safety, whether based on empirical evidence, hard research or best practices.

New products in development include:

▪ Annual report on the state of patient safety
▪ Patient safety facilitator certification program
▪ Patient safety risk assessment tool
▪ Patient safety research library
▪ Team training
▪ Development of a culture of patient safety
▪ International web-based risk assessment tool
▪ Solutions development and system design and redesign

IHI - 100,000 Lives Campaign


Institute for Healthcare Improvement (IHI) and other organizations are convinced that a remarkably few proven interventions, implemented on a wide enough scale, can avoid 100,000 deaths over the next 18 months, and every year thereafter.
The Campaign IHI will join hands with other leading American health care organizations in launching an unprecedented 100,000 Lives Campaign, which will disseminate powerful improvement tools, with supporting expertise, throughout the American health care system.
This campaign aims to enlist thousands of hospitals across the country in a commitment to implement changes in care that have been proven to prevent avoidable deaths. IHI starting with these six changes:

· Deploy Rapid Response Teams…at the first sign of patient decline
· Deliver Reliable, Evidence-Based Care for Acute Myocardial Infarction…to prevent deaths from heart attack
· Prevent Adverse Drug Events (ADEs)…by implementing medication reconciliation
· Prevent Central Line Infections…by implementing a series of interdependent, scientifically grounded steps called the “Central Line Bundle”
· Prevent Surgical Site Infections…by reliably delivering the correct perioperative antibiotics at the proper time
· Prevent Ventilator-Associated Pneumonia…by implementing a series of interdependent, scientifically grounded steps called the “Ventilator Bundle”

CMS - MMA §646: Medicare Health Care Quality Demonstration Program

Section 646 of the Medicare Modernization Act directs the Centers for Medicare & Medicaid Services (CMS) to establish a 5-year program of demonstration projects to encourage improvements in quality.
Fact Sheet (.pdf 23 KB)

Resources and reference materials
The following information is being made available to organizations and individuals interested in learning more about the MMA 646 demonstration program. Click on the links to download or view the materials.
Conference Proceedings (.pdf 46kb) "Transforming Health Systems Through Leadership, Design and Incentives", October 18-19, 2004
Environmental Scan (.pdf 835 kb) Leading Practices in System Redesign", Draft, December 18, 2004.
Legislation (.pdf 50 kb) The text of the MMA §646 (Pub. L. 108-173) and the report of the conference committee (H. Rpt. 108-391) that accompanied the Medicare Modernization Act

AHRQ - Tools for Hospitals and Health Care Systems

This fact sheet describes some tools recently developed for hospitals and other providers from research of the Agency for Healthcare Research and Quality (AHRQ).
Select to download print version (PDF File, 175 KB).

Examining Performance
Assessing Emergency Preparedness
Improving Organization
Enhancing Care