Milbank Quarterly - Improving the Quality of Long-Term Care with Better Information

Vincent Mor
Milbank Quarterly September 2005 83 (3): 333–64

click here for full text

JAMA - Quality, Innovation, and Value for Money

NICE and the British National Health Service
Steven D. Pearson; Michael D. Rawlins
JAMA. 2005;294:2618-2622.
ABSTRACT FULL TEXT PDF

WHO/Europe – What are the advantages and limitations of different quality and safety tools for health care?

The term "quality tools" is used in many different ways to refer to a method used by an individual, a team, an organization or a health system. It is most often used in a narrow sense in American texts to refer to a set of simple "continuous quality improvement" methods (CQI tools).

More broadly, it includes many other safety and quality methods, frameworks, programmes or systems. Some are diagnostic methods to help decision-making, some are for intervention and change only, and some include both methods for diagnosis and intervention.

What are the advantages and limitations of different quality and safety tools for health care?

A Health Evidence Network (HEN) analysis of the effectiveness of different tools for improving quality of care in hospitals and communities.

Report

CMS - National Implementation of Hospital Consumer Assessment of Health Providers and Systems (HCAHPS)

The Centers for Medicare & Medicaid Services (CMS) recently released the final Hospital CAHPS (HCAHPS) survey instrument.

The intent of the HCAHPS initiative is to provide a standardized survey instrument and data collection methodology for measuring patients’ perspectives on hospital care.

HCAHPS can be viewed as a core set of questions that can be
combined with a broader, customized set of hospital-specific items.

Once HCAHPS is fully implemented its results will be publicly reported on the Hospital Compare website

• CMS10102-SS.pdf 332KB Supporting Statement and Instrument_Survey
• CMS10102-Response.pdf 283 KB Response to Comments Dated 10-27-05
• CMS10102-Instructions.pdf 23 KB Instructions for Completing the 83-I
• CMS – HCAHPS
• AHRQ - Fact Sheet HCAHPS®

The Sorry Works! Coalition

The Sorry Works! Coalition is a new, nationwide organization of doctors, lawyers, insurers, and patient advocates dedicated to promoting full-disclosure and apologies for medical errors as a “middle ground solution” to the medical liability crisis.

The coalition advocates that after every bad outcome or adverse event hospitals and doctors perform root cause analyses to determine if the standard of care was met.

If a root cause analysis showed that the standard of care was not met (i.e, a medical error, negligence), the hospital staff and doctors apologize to the patient/family, provide an explanation of what happened and how the hospital will fix the procedures so the error is not repeated, and make a fair offer of upfront compensation. The hospital attorney and plaintiffs’ attorney will usually negotiate the compensation and the case will be closed in a short period of time.

If, however, the standard of care was met (no errors), the hospital still meets with the patient/family and their attorney(s) and explains what happened, provides medical charts, and answers all questions. Hospitals and doctors show compassion, prove their innocence, and avoid any appearance of a cover up.

www.sorryworks.net

IOM - Improving the Quality of Health Care for Mental and Substance-Use Conditions

Quality Chasm Series


This new report Institute of Medicine (IOM)examines the difference between overall health care and health care for mental and substance-use conditions and finds that the framework set forth in the 2001 report, Crossing the Quality Chasm, can be applied to health care for mental and substance-use conditions.

The report then describes a multifaceted and comprehensive strategy to do so.
www.iom.edu/report.asp?id=30836

The AMA - "Making Strides in Safety"

www.ama-assn.org/ama/pub/category/15010.html

The AMA is working as a strategic partner with the Institute for Healthcare Improvement (IHI) in the 100,000 Lives Campaign, which aims to educate physicians on ways to enhance patient safety in the hospital setting.

Hospitals can implement any or all of the programs, including:

• Deployment of "Rapid Response Teams"
• Assurance of optimal care for patients with acute myocardial infarction
• Prevention of ventilator-associated pneumonia
• Prevention of surgical-site infections
• Prevention of adverse drug events
• Prevention of central line infections

The AMA has developed educational materials to help you get hospital involved in this campaign.

Download a participation toolkit (PDF, 310KB), which provides step-by-step instructions on how to get started or an implementation toolkit (PDF, 372KB), which assists involvement in the campaign.

CMS - Requires Hospitals to submit data on Implantable Cardioverter Defibrillator (ICD)

ICD Registry™

In accordance with the ICD National Coverage Determination (NCD), hospitals must submit data on all ICD implantations that were performed for primary prevention and occurred on or after January 2005.

Medicare intends to purchase the minimum data necessary to ensure that the appropriate beneficiaries are receiving ICDs as required by the NCD.

In addition, CMS plans to use data from the American College of Cardiology National Cardiovascular Data Registry (ACC-NCDR®) ICD Registry™ in order to equip the public with the ability to compare quality metrics for facilities that implant ICDs for the primary prevention of sudden cardiac death.

CMS also hopes to answer several key questions about ICD implantation, including: whether complications vary by device manufacturer or device type; whether patient outcomes (i.e., morbidity and mortality) differ among patients based on clinical characteristics, device characteristics, the facility and/or physician who implants the device, etc.

As it becomes available, this aggregate information will be posted to the CMS Coverage web site at www.cms.hhs.gov/coverage.

Health Affairs - Rethinking Health Reform

November/December 2005 - Volume 24, Number 6

• The Struggle That Never Ends: Reforming U.S. Health Care - John K. Iglehart
• Health Care Reform: Why? What? When? - Victor R. Fuchs and Ezekiel J. Emanuel
• Whence And Whither Health Insurance? A Revisionist History - Donald W. Moran
• The Political Divide In Health Care: A Liberal Perspective -Thomas Bodenheimer
• The Rise In Health Care Spending And What To Do About It - Kenneth E. Thorpe
• Making Markets Work: Five Steps To A Better Health Care System - John F. Cogan, R. Glenn Hubbard, and Daniel P. Kessler
• Federalism And Health Policy - Richard P. Nathan
• Health Insurance In Mexico: Achieving Universal Coverage Through Structural Reform - Felicia Marie Knaul and Julio Frenk
• Managed Consumerism In Health Care - James C. Robinson
• Reviving Managed Care With Health Savings Accounts - Mark A. Hall and Clark C. Havighurst
• Coordinated Agency Versus Autonomous Consumers In Health Services Markets - Bryan E. Dowd
• Competition In Health Care: Its Evolution Over The Past Decade - Paul B. Ginsburg
• Competition And New Technology - Mark V. Pauly
• Which Way For Competition? None Of The Above - Robert A. Berenson
• The Delivery System Matters - Francis J. Crosson
• Why Employers Need To Rethink How They Buy Health Care - Robert S. Galvin and Suzanne Delbanco
• Consumer-Driven Health Care: Just A Tweak Or A Revolution? - Greg Scandlen
• The 100,000 Lives Campaign: Crystallizing Standards Of Care For Hospitals - Alice G. Gosfield and James L. Reinertsen
• Reporting Clinical Trial Results To Inform Providers, Payers, And Consumers - Rodney A. Hayward, David M. Kent, Sandeep Vijan, and Timothy P. Hofer

AHRQ - National Resource Center Health IT Teleconference Series

Making Health IT Work

Three state-of-the art teleconferences sponsored by the Agency for Healthcare Research and Quality's (AHRQ) National Resource Center for Health Information Technology will walk through the steps of three challenging enterprises: external collaboration, EHR readiness assessment, and health IT implementation.

• Community-Based Health IT Initiatives: How Do You Make Them Work?
• Are You Ready for EHRs? How to Make that Assessment
• Getting Started with Health IT Implementation

All three national conferences are free and open to the public.
event registration website

AMA - Opposes Physician Voluntary Reporting Program

The American Medical Association (AMA) is urging the Centers for Medicare and Medicaid Services (CMS) not to implement the Physician Voluntary Reporting Program (PVRP) that would measure quality of care from physician offices starting in January 2006.

In a letter to CMS the AMA said:




AMA letter

CMS/Premier - Hospital Quality Incentive Demonstration (HQID)

Data from the first year

“Pay-for-performance” can increase clinical quality and save lives, according to the first year of official data from a national project involving more than 260 hospitals. The Centers for Medicare and Medicaid Services (CMS) will pay $8.85 million in incentives to the top-performing hospitals in the project, which is managed by Premier Inc.

Data from the first year of CMS/Premier Hospital Quality Incentive Demonstration (HQID), validated by CMS and reported publicly, demonstrate a significant improvement in the quality of care across five clinical focus areas as measured by 33 nationally standardized and widely accepted quality indicators.

Year 1 Results release

CMS/Premier Hospital Quality Incentive Demonstration

CMS - Physician Voluntary Reporting Program

As part of its overall quality improvement efforts, CMS is launching the Physician Voluntary Reporting Program (PVRP).

This new program builds on Medicare’s comprehensive efforts to substantially improve the health and function of beneficiaries by preventing chronic disease complications, avoiding preventable hospitalizations, and improving the quality of care delivered. Under the voluntary reporting program, physicians will be asked to help capture data about the quality of care provided to Medicare beneficiaries.

Voluntary reporting of quality data through the PVRP will begin in January 2006.

The PVRP will begin with 36 evidence-based quality performance measures (these clinically valid measures have been part of the guidelines endorsed by physicians and the medical specialty societies and are the result of extensive input and feedback from physicians and other quality care experts).

Additional quality measures are under development now and could be phased-in for reporting later in 2006.

• Overview
• PVRP Background and General Instructions
• G-Code Specifications and Instruction for Clinical Measures
• Medlearn Matters article
• Change Request

AHRQ - CERTs Annual Report: Year 5

The Centers for Education & Research on Therapeutics (CERTs) program was created to investigate and research specific areas of therapeutics, and to use this knowledge to educate consumers, health care providers, and policymakers about the risks and benefits of such therapies.

The CERTs were established in 1999 by the Agency for Healthcare Research and Quality (AHRQ) in consultation with the U.S. Food and Drug Administration (FDA).

The CERTs consist of a network of research centers, a coordinating center, a steering committee, and numerous partnerships with public and private organizations dedicated to improving the quality and safety of therapeutics.

This report highlights a number of CERTs research and educational projects completed in the past year. It also includes some of the projects currently in progress and in the planning stages.

CERTs Annual Report: Year 5 (PDF File, 3.8 MB)

Overview: Fact Sheet

IOM - 35th Annual Meeting to Focus on Pharmaceuticals

As part of its 35th annual meeting, the Institute of Medicine host an all-day public symposium, "Pharmaceuticals in the 21st Century"

Agenda and Slide Presentations

A specific presentation pointed to Drug Safety:

Improving Drug Safety: A Systems Approach
Brian L. Strom, M.D., M.P.H., Professor and Chair, Department of Biostatistics and Epidemiology and Director, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine
View Slides

AHRQ - launched its first audio newscast

This audio podcast features current news and information from the U.S. Agency for Healthcare Research and Quality (AHRQ) Features include:

• A look at this week's AHRQ’s News & Numbers.
• AHRQ’s patient safety research found that physician groups are slow to adopt electronic health records.
• "Learning from Errors" segment reports on two studies, one examining the impact of nurse fatigue and the other on ICU patients.
• AHRQ releases a New Publication to help consumers understand and get quality health care called the: Guide to Health Care Quality: How to know it when you see it.
• Finally, a look at the first podcast produced by the U.S. Department of Health and Human Services.

listen to the audio newscast

Medical Care - Hospital Level of Care and Neonatal Mortality in Low- and High-Risk Deliveries

Reassessing the Question in Sweden by Multilevel Analysis
Medical Care. 43(11):1092-1100, November 2005.
Merlo Juan; Gerdtham Ulf-G; Eckerlund Ingemar; Hakansson Stefan; Otterblad-Olausson Petra; Pakkanen Milla; Lindqvist Pelle-G

Abstract
HTML
PDF

Medical Care - Effects of New Zealand's Health Reengineering on Nursing and Patient Outcomes

Medical Care. 43(11):1140-1146, November 2005.
McCloskey, Barbara A. ; Diers, Donna K.

Abstract
HTML
PDF (361 K)

AHRQ - Health Information Technology, Quality of Care, and Evidence-based Medicine

An Interlinked Triad
Remarks by Carolyn Clancy, M.D., Director of the Agency for Healthcare Research and Quality
Annual Symposium, American Medical Informatics Association
Washington, D.C., October 25, 2005

Introduction
Momentum for Health IT
The Coming Revolution
Quality and Health IT
Effective Health Care
What's Next

Medical Care - Comorbidity

Comorbidity Indices to Predict Mortality From Medicare Data: Results From the National Registry of Atrial Fibrillation.
Yan Yan, Elena Birman-Deych, Martha J. Radford, David S. Nilasena, Brian F. Gage.
Medical Care. 43(11):1073-1077, November 2005

Abstract
HTML
PDF (194 K)


Coding Algorithms for Defining Comorbidities in ICD-9-CM and ICD-10 Administrative Data.
Hude Quan; Vijaya Sundararajan; Patricia Halfon; Andrew Fong; Bernard Burnand; Jean-Christophe Luthi; L Duncan Saunders; Cynthia A. Beck; Thomas E. Feasby; William A. Ghali.

Abstract
HTML
PDF (351 K)

CMWF - Taking the Pulse of Health Care Systems

Experiences of Patients with Health Problems in Six Countries
Cathy Schoen, Robin Osborn, Phuong Trang Huynh, Michelle Doty, Kinga Zapert, Jordon Peugh, Karen Davis
Health Affairs Web Exclusive, November 3, 2005, W5-509–W5-525

A new Commonwealth Fund international survey report on health care access, safety, and care coordination in Australia, Canada, Germany, New Zealand, the U.K., and the U.S.

The survey found no one nation best or worst overall on the measures studied. But the U.S. stood out for high error rates, inefficient care coordination, and high out-of-pocket costs that serve as barriers to access.

• More than one of four patients in each country (28% to 32%) said risks were not completely explained during their hospital stay.
• In all countries, sizable majorities of patients said physicians had not always reviewed all their medications during the past year, and one-third or more reported infrequent reviews.
• Across countries, one-sixth to one-fourth of patients said physicians only sometimes, rarely, or never make goals of care and treatment clear or give them clear instructions.
• Relative to the U.S. and Canada, the four countries reporting comparatively rapid access to physicians— Australia, Germany, New Zealand, and the U.K.—also had significantly lower rates of emergency room use.

Chartpack pdf[download] ppt [download]

Topline Results [download]

In the Literature [download]

Commonwealth Fund publication details

Press release

Kaiser Family Foundation - Conversations on Health

Hosted by former ABC News Correspondent and current Kaiser Family Foundation Vice President and Senior Advisor for Communications Jackie Judd, Kaiser Conversations on Health is a series of live interviews with leading newsmakers discussing major health issues.

• October 20, 2005 -- Aetna CEO Dr. John W. "Jack" Rowe
• June 14, 2005 -- NIH Director Dr. Elias A. Zerhouni
• April 14, 2005 -- Virginia Governor Mark Warner
• March 24, 2005 -- Former Health and Human Services (HHS) Secretary Tommy Thompson
• September 29, 2004 -- Centers for Medicare & Medicaid Services (CMS) Administrator Mark McClellan
• March 3, 2004 -- AARP CEO Bill Novelli
• December 3, 2003 -- Irish rock star Bono, founder of the debt, AIDS and trade advocacy group DATA
  
  

Qual Saf Health Care - Effectiveness of routine reporting

to identify minor and serious adverse outcomes in surgical patients
P J Marang-van de Mheen, N van Hanegem, and J Kievit
Qual Saf Health Care 2005; 14: 378-382.
[Abstract] [Full text] [PDF]

Qual Saf Health Care - Measuring patient safety climate

a review of surveys
J B Colla, A C Bracken, L M Kinney, and W B Weeks
Qual Saf Health Care 2005; 14: 364-366.
[Abstract] [Full text] [PDF]

J Clin Epidemiol - A review of uses of health care utilization databases for epidemiologic research on therapeutics

Schneeweiss S, Avorn J.
J Clin Epidemiol. 2005 Apr;58(4):323-37
Pubmed