VHIG Digest: Volume 1, No. 2
By Irving Ye, MD/MBA Candidate 2012
In the News
1. VA Health System Shines in Quality-of-Care Study (11/9)
A report in the November issue of the national publication Medical Care finds that the Department of Veterans Affairs (VA) health system generally outperforms the private sector in following recommended processes for patient care. The study authors, led by Dr. Amal Trivedi of the Providence, R.I., VA Medical Center and Brown University, cite possible reasons for VA’s more positive performance, including integration of health care settings, use of performance measures with an accountability framework, disease-management practices and electronic medical record or health information technology. Among the specific findings of the review include: greater adherence to accepted processes of care—or better health outcomes—in VA; similar mortality rates following a heart attack or other coronary event in VA and non-VA settings; better adherence to guidelines for diabetes care at VA; higher rates of vaccination against flu and pneumonia for the elderly in VA.
2. F.D.A. Urges Two Steps for Safer CT Scans (11/9)
The Food and Drug Administration has concluded that manufacturers of CT scanners should do a better job of training and educating those who use their equipment, and that the machines themselves could be made safer by warning operators that a dangerously high radiation dose is about to be administered.
These two conclusions are the result of a yearlong investigation by the F.D.A. into hundreds of radiation overdoses in 2008 and 2009 that occurred during a specific diagnostic test for a stroke, called a CT brain perfusion scan. The agency had earlier concluded that equipment failure played no role in the overdoses, which left dozens of patients in California and Alabama with a variety of ailments, including hair loss, confusion and memory problems.
Higher-than-expected doses were reported in at least a half dozen hospitals, with most occurring at Cedars-Sinai Medical Center in Los Angeles, where the overdoses were first discovered. The hospital told The Times that it had found 269 patients who received more radiation than expected. The F.D.A. said that it had to rely in part on numbers provided by manufacturers and that its number was somewhat lower.
3. Quality of care low at notable university hospitals (11/2)
Despite the common assumption that university-affiliated hospitals offer better care than their non-university counterparts, a new study published this week by medical rankings service CareChex found that just the opposite is true.
In terms of overall quality of care, for instance, many notable facilities–including George Washington University Hospital, Stanford Hospital, Johns Hopkins Hospital and the University of Chicago Medical Center–performed in the bottom 25 percent of all hospitals nationwide. Nearly 90 percent of all university hospitals performed below the national average for orthopedic care, while 85 percent were below the national average for general surgery, according to the study, which was published on behalf of healthcare information service company, The Delta Group.
Some of those factors, according to Dr. Thane Forthman (managing principal of The Delta Group), include residents’ lack of experience, as well as extended work shifts of up to 80 hours per week. Despite the findings, university hospitals were more likely to provide better cancer care and better medical care overall. Forty-three percent of the university hospitals studied ranked in the top 10 percent for cancer care, with 17 percent in the top 10 percent for overall care.
CareChex looked at 118 university hospitals overall, evaluating them based on The Delta Group’s National Quality Ranking Database. That database includes nearly all general, acute, non-federal U.S. hospitals, and pulls information from the Hospital Quality Alliance’s Hospital Compare All Payer database and CMS’s Hospital Consumer Assessment of Healthcare Providers and Systems database.
In the Literature
1. Geographic Variation in the Quality of Prescribing
Findings: The quality of prescribing for the elderly varies substantially among local markets — substantially more, in fact, than does spending on drugs overall. The study results do not support the theory that high-spending areas simply use more of everything, including inappropriate drugs, since the association between overall drug spending and inappropriate prescribing is weak. In addition, because spending on nondrug medical care is positively associated with a greater use of potentially harmful drugs, our results also do not suggest that more medical spending is associated with better health care overall. The study results are consistent, however, with an association between lower-quality prescription patterns and more adverse drug events that may require additional expense to treat.
Source: Zhang Y, Baicker K, Newhouse JP. Geographic Variation in the Quality of Prescribing. N Engl J Med. 2010 Nov 3.
2. Topic Paper: Health care reform in 2010: transforming the delivery system to improve quality of care
The authors evaluated the medical, legal, and public policy literature (both print and electronic) related to contemporary health care reform efforts, summarized the Patient Protection and Affordable Care Act of 2010 (PPACA), and examined four cost-containment and/or quality-improvement mechanisms related to Medicare payment policy that will be implemented by this recently passed law.
Source: Filson CP, Hollingsworth JM, Skolarus TA, Quentin Clemens J, Hollenbeck BK. Health care reform in 2010: transforming the delivery system to improve quality of care. World J Urol. 2010 Nov 3.