Quality Matters Archive

Quality Matters reported on emerging models and trends in health care delivery reform and interviews with leaders in the field. Please read its successor, Transforming Care.

  • April/May 2010 Issue
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News Briefs

U.S. Medical Schools Not Training Physicians to Provide Safe Care, Report Says
Medical schools are not adequately training students to follow safe practices, analyze bad outcomes, and work in teams to design safe care processes, according to a March report from the Lucian Leape Institute at the National Patient Safety Foundation. Unmet Needs: Teaching Physicians to Provide Safe Patient Care was published during Patient Safety Week, which marks the 10th anniversary of the Institute of Medicine's report, To Err Is Human. That report found that as many as 98,000 Americans die each year of preventable medical errors.

"Despite concerted efforts by many conscientious health care organizations and health professionals to improve and implement safer practices, health care remains fundamentally unsafe," said Lucian L. Leape, M.D., the Institute's chair and a leader in patient safety.

According to the report, the patient safety movement has been hampered by inadequate medical education and residency training. Most medical schools do not teach safety science, human factors science, systems thinking, and improvement strategies, all of which are needed to identify and address safety concerns. In addition, schools are not helping students cultivate the interpersonal skills they will need to work with their colleagues in care teams. And the hierarchical culture of most teaching hospitals inhibits adherence to safe practices and transparency, the report concludes.

Texas Nurse Who Reported Physician to Medical Board Acquitted
In February, a jury acquitted a Texas nurse who had been charged with a felony after alerting the state medical board of her concerns that a doctor at her hospital was practicing unsafe medicine. The incident, which received national media attention, sparked fears among patient safety advocates that health care workers would be discouraged from speaking up when they suspect cases of improper medical care.

The prosecution argued that the nurse, Anne Mitchell, who had worked at Winkler County Memorial Hospital in West Texas for 25 years, had disseminated confidential information—specifically, patient file numbers—in her letter to the medical board as part of a personal vendetta against Dr. Rolando G. Arafiles, Jr. The defense presented evidence that Mitchell's concerns were well placed.

Mitchell and a colleague who had helped her write the letter were both fired by the hospital after their indictment; they are now pursuing a case against the county, the hospital, and several officials, arguing that their firings and indictments amounted to a violation of their due process and First Amendment rights.

Medical Group Urges New Safety Rules on Radiation
In February, the leading professional organization dedicated to radiation oncology committed to enhancing safety measures for administering medical radiation. The American Society for Radiation Oncology promised to develop a stronger accreditation program, expand training on safety, and enhance its compliance program to ensure that medical technologies from different manufacturers can safely transfer information to reduce the chance of a medical error.

The group also will push for federal legislation to require national standards for radiation therapy treatment teams. It began a comprehensive review of existing policies after a series of articles in The New York Times reported on the harm that can result when using powerful and technologically complex radiation machines.

OIG Identifies Best Methods for Identifying Adverse Events
An Office of the Inspector General (OIG) report evaluating the usefulness of various methods for identifying events that harm hospitalized Medicare beneficiaries found that nurse review and one type of billing data analysis identified the greatest number of adverse events. Still, the analysis found that billing data were often inaccurate or incomplete—indicating that Medicare's automated payment software may not be able to identify hospital-acquired conditions, which may result in overpayments. Further, hospitals in many cases did not identify adverse events through internal incident reports.

The report recommends that the Centers for Medicare and Medicaid Services (CMS) explore opportunities to identify adverse events when conducting medical record reviews. CMS also should ensure that hospitals accurately code claims data to allow for identification of hospital-acquired conditions affected by Medicare's payment policy. CMS does not make additional payments for certain hospital-acquired conditions.

Hospital Group: 'Meaningful Use' Regulations Not Realistic For Many Providers
In a March 8 letter to the Centers for Medicare and Medicaid Services, the American Hospital Association (AHA) argued that the proposed "meaningful use" requirements for use of electronic health record adoption may be out of reach for many health care providers. Under the requirements, physician practices and hospitals that show they make meaningful use of electronic health records will quality for incentive payments from Medicare and Medicaid beginning in 2011; by 2015, providers that do not demonstrate such meaningful use will be subject to reduced payments under Medicare.

In the letter, the AHA questioned the short time frame—eight months until the program begins—and "all-or-nothing" approach that requires providers to meet every measure of meaningful use before qualifying for incentive payments. Instead, the AHA recommends using an incremental approach that would reward progress toward established goals.

"We fear that the ultimate impact of the program actually could be the opposite of the goal of an e-enabled health care system, as those who are furthest behind may well be discouraged by the steep adoption curve," the letter said.

In addition, the AHA noted the limited capacity of health IT vendors and workforce, as well as limited numbers of clinical staff with IT training.

Separately, a recent Medical Group Management Association survey found that more than two-thirds of physicians believe their productivity will decrease as they strive to meet the "meaningful use" requirements for health IT—even after a period of adjustment to electronic health record implementation. In particular, many respondents say it will be difficult to provide patients with electronic copies of their health records within the specified time frames (48 hours for 80 percent of patient requests).

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