IOM Report: Revised Hours Needed to Prevent Resident Errors
An Institute of Medicine (IOM) report on reducing fatigue-related mistakes by medical residents recommended decreasing to 16 the number of hours that residents can work without time for sleep. The report, which was released in December, also suggested that residency programs better define off-duty periods between shifts, increase the number of mandatory days off, and restrict moonlighting during residents' off hours. However, the IOM did not propose altering the hours that residents can work from a maximum average of 80 per week, as set by the Accreditation Council for Graduate Medical Education in 2003.
The report also highlighted the need for closer supervision—particularly of first-year residents—to reduce errors, lower patient mortality, and improve quality of care. The IOM also proposed limiting residents' patient caseloads based on their experience and specialties, and increasing the overlap of residents scheduled during shift changes to reduce errors during patient handovers.
These changes would not come without a financial cost, estimated at $1.7 billion, as some of the work currently performed by residents would have to be done by others. But the cost of additional personnel, the report notes, would likely be offset by savings that accrue due to a reduction in the injuries that need to be treated as a result of medical errors.
Cost and Quality Transparency Essential for High-Performing Systems
New York City Health and Hospitals Corporation (HHC)—the largest municipal public hospital system in the United States—made a commitment in 2001 to promote greater health care transparency. This initiative, which is reviewed in a recent Joint Commission Journal on Quality and Patient Safety article, began by having staff members share performance data as part of their participation in learning collaboratives. Internal data-sharing later spread to HHC facilities and ultimately to the board of directors.
In 2007, HHC leaders launched HHC in Focus, a public reporting Web site that provides performance data on each of the system's component facilities, as well as the corporation as a whole. Publicly reported measures include chronic disease management and outcomes, infection prevention, and overall mortality; data on public health interventions, like smoking cessation, are also available.
While the effect of public reporting at HHC has not been systematically studied, performance indicators have continued to improve, suggesting that it is playing an important role in stimulating quality and patient safety, the authors conclude.
A New Health Care Quality Improvement Resource: WhyNotTheBest.org
The Commonwealth Fund has launched a new Web site, WhyNotTheBest.org, that allows health care providers, researchers, and professionals to easily conduct side-by-side comparisons of 4,500 hospitals nationwide. On the Web site, users can search publicly reported Centers for Medicare and Medicaid Services performance data by a number of hospital characteristics—including region, ownership, and size—and measure performance on 24 nationally recognized measures of health care quality against top performers and state and national averages. Case studies of high-performing hospitals and a library of tools offer lessons and strategies on ways to improve care. Featured tools include materials created by the Institute for Healthcare Improvement, the Agency for Healthcare Research and Quality, the American Heart Association, and top hospitals around the country.
NQF Forms Partnership to Improve Care
The National Quality Forum (NQF) convened the National Priorities Partnership (NPP), a coalition of 28 national health care organizations, to address the challenges facing the health care system in light of the current economic crisis. The coalition, which met for the first time in November, includes groups representing consumers, purchasers, quality alliances, and health professionals and seeks to establish national priorities and goals for performance measurement and public reporting.
NPP has already identified the following priorities: increasing patient and family engagement in health care decisions, improving population health, safety, care coordination, ensuring palliative and end-of-life care, and eliminating overuse. The Partnership committee is co-chaired by Don Berwick, M.D., M.P.P., president and CEO of the Institute for Healthcare Improvement, and Margaret O'Kane, president of the National Committee for Quality Assurance.
NYC Doctors Given Incentives to Use EHRs, Improve Public Health
The New York Times reported in December that about 1,000 of the city's primary care physicians—many located in three of the city's poorest areas: Harlem, the South Bronx, and central Brooklyn—began collecting their patients' health information electronically over the past year. Their efforts are part of a $60-million city health department project that aims to harness electronic data for public health goals, including monitoring disease frequency, cancer screening, and substance abuse.
Participating physicians are given subsidies to implement an electronic health record system, designed for the city by Mass.–based eClinicalWorks. The system—which would cost a typical doctor's office about $45,000 to implement—is offered to offices with at least 10 percent of their patients on Medicaid or uninsured, for $24,000. Offices in neighborhoods with the highest poverty rate pay $10,000.
In April, the health department plans to send participating physicians report cards comparing their preventive efforts with that of their peers. Doctors who hit specified targets for controlling blood pressure or cholesterol will soon be offered bonuses of "perhaps $100 for each patient… up to $20,000 for each doctor," the Times reported.
Ohio Health Summit Focuses on Strategies to Achieve High Performance
Health care providers, business leaders, government officials, and health care advocates from across Ohio came together in November to reach consensus on the best ways to ensure the state has a high-quality, cost-effective health system by 2013. This effort stemmed from Ohio's participation in the Commonwealth Fund/Academy Health Sate Quality Improvement Institute, which aimed to help states select and target quality indicators to improve health system performance.
The recommendations coming out of the summit focused on: improving efficiency and decreasing health care costs; improving chronic disease management; promoting health through personal responsibility and disease and injury prevention; and improving patient safety and reducing errors. An implementation team was convened to develop next
