VHIG Digest: Vol. 3, No. 4
This Week’s Top 3 Stories in Patient Safety and Quality Improvement in Healthcare
By Michele Luhm Vigor, School of Medicine, Class of 2014
1. The Joint Commission Names Names: Annual Report on Quality and Safety 2011- 9/13/11
This past week, the nation’s leading hospital accreditation board released their annual report on quality and safety:Improving America’s Hospitals. The reporting is a measure of accountability, with scores based on diligence in following protocols when treating conditions like heart attack, pneumonia, and childhood asthma attacks. For the first time ever, the names of the top-performing hospitals were made public. This list of 405 represents about 14% of hospitals under accreditation and contains a disproportionately high number of rural and small hospitals, and includes 20 Veterans Affairs medical centers. The country’s highest-regarded hospitals were almost universally missing from the list, which included only those hospitals achieving quality measures above a 95% threshold. Hospital quality experts acknowledge that because these are measures of process, not of outcomes, failure to reach the 95% threshold cannot be explained away by having sicker and more complicated patients. While higher volume hospitals are busier and generally have more reporting to do, they also have more resources to meet these goals. As there is an increasing trend of hospital reimbursements being tied to quality measures like infection rates and readmissions, compliance with procedural standards will become even more consequential moving forward. The Joint Commission plans to withhold accreditation from any hospital that posts a composite score below 85 percent.
Some of the key findings were a nine year composite performance improvement of 14.8% in accountability measures in America’s hospitals Ð a significant enhancement in patient safety. Hospitals have significantly improved the quality of care provided to heart attack, pneumonia, surgical care and children’s asthma care patients, according to composite accountability measures results. Fifteen new measures were introduced last year. There is still room for improvement: some of the lowest performance measures included providing fibrinolytic therapy within 30 minutes to heart attack patients and providing antibiotics to (immunocompetent) intensive care unit pneumonia patients.
2. AHA Fights Penalties, Says Some Readmissions Warranted – 9/14/11
While some of the 2 million annual Medicare patient hospital readmissions (within 30 days of discharge) are likely to be evidence of low-quality care, the American Hospital Association (AHA) is urging stakeholders to reassess the use of readmission rates as a determinant of payment penalties. They claim that the current language does not differentiate between unplanned and planned readmissions, and express concern that hospitals will be discouraged to appropriately admit patients in need of care and exacerbate inequities.
Article: Advisory Board Company [subscription required, free for Vanderbilt students and faculty]
3. Million Hearts Initiative Aims to Prevent Strokes, Heart Attacks – 9/13/11
In order to get all physicians on board with quality reporting, the Department of Health and Human Services (HHS) has unveiled an ambitious plan to reduce cardiovascular disease that will have a wide effect on physicians, ranging from quality bonuses to electronic health record (EHR) systems. By incentivizing a greater focus on existing cardiovascular measures of quality care, the initiative aims to prevent 1 million heart attacks and strokes over the next 5 years through clinical interventions and changes in diet, exercise, and tobacco use. The “ABCS” of clinical prevention include aspirin for high-risk patients, blood-pressure control, cholesterol management, and smoking cessation.
Strokes and heart attacks strike more than 2 million Americans each year, half of whom die, according to HHS. “This isn’t just a human tragedy, it’s also a huge drain on our economy,” HHS Secretary Kathleen Sebelius commented during a press conference, noting that medical costs and lost productivity related to cardiovascular disease add up to roughly $450 billion a year. The cure is far less expensive, she said. “We know that most heart attacks and strokes can be prevented with simple, low-cost care.”