Web-Based Tool Helps Doctors Improve Care
According to two independent studies, a Web-based tool developed by Kaiser Permanente helps physicians provide better care for patients with diabetes and heart disease, and also helps them provide better preventive care to all patients. The Panel Support Tool extracts information from electronic heath records for individuals and groups of patients, and then compares the care patients are receiving to recommended care based on national guidelines.
One study of the Web-based tool, published October 4 in the American Journal of Managed Care, followed 204 primary care teams using the tool for three years. It found that the percentage of recommended care delivered each month increased from 67.9 percent to 72.6 percent from 2005 to 2007 among patients with heart disease, and from 63.5 percent to 70.6 percent among patients with diabetes. The second study, published October 1 in Population Health Management, found that recommended preventive care (based on 13 indicators) improved from 72.9 percent to 80 percent among 207 primary care teams using the tool over 20 months.
The tool could encourage more proactive use of electronic health records. Many experts agree that having such records will not on its own lead to improvements in the quality of care; providers must use the tools to analyze their patient panels and pinpoints gaps in needed care.
IoM Report Says Nurses Could Lead Performance Improvements
A report published this month by the Institute of Medicine (IoM) called for nurses to pursue higher levels of education and training to play greater roles in strengthening the health care system. With more than 3 million in their ranks, nurses are the largest segment of the health care workforce. Public and private organizations need to provide incentives and support for nurses to pursue advanced degrees and training—in particular to fill the faculty and advanced practice roles that are currently experiencing a shortage of qualified individuals. For example, nursing schools should ensure that at least 10 percent of their graduates enter a master's a doctor program within five years. In addition, the report recommends that "scope of practice" barriers imposed by states, federal agencies, and health care organizations be removed to enable nurses to practice to the full extent of their training. Nurses should also contribute to management teams and boards that help shape health care delivery systems, the report says.
Joint Commission Report: "Encouraging" Improvements in Hospital Care
There have been major gains in the quality of care delivered in U.S. hospitals, according to the Joint Commission's latest report on quality and safety released in September. The analysis is based on data from 3,000 hospitals accredited by the organization. It found steady improvement over eight years on evidence-based measures of care processes for heart attack, pneumonia, surgery, and children's asthma. For example, overall performance on recommended heart attack care improved from 88.6 percent in 2002 to 97.7 percent in 2009. Recommended surgical care was delivered 77.4 percent of the time in 2004, but 95.8 percent of the time in 2009, based on a composite of eight recommended care processes. The report pointed to certain areas still in need of improvement, including provision of fibrinolytic therapy to heart attack patients within 30 minutes of arrival to the hospital. In the report, the Joint Commission announced plans to explore integrating performance measures into their accreditation standards.
Study: CMS Surgical Care Measures Not Linked to Outcomes, Complications
A study published in the latest issue of the Archives of Surgery found no strong correlation between compliance with surgical process-of-care measures reported on the Centers for Medicare and Medicaid Services (CMS) Web site, Hospital Compare, and a hospital's risk-adjusted mortality and surgical complication rates. Moreover, hospitals that had worse compliance with the process-of-care measures had fewer patients with complications, while those with higher compliance levels had higher complication rates. The study used data from 2005 to 2006 from some 2,189 U.S. hospitals. The surgical process-of-care measures assess how often hospitals provide recommended care, such as providing antibiotics when necessary. In 2008, CMS began adding data on outcomes, including mortality and readmission rates. The authors conclude that currently available information on Hospital Compare will not help patients identify hospitals with better outcomes for high-risk surgery, and suggest that CMS needs "to identify higher leverage process measures and devote greater attention to profiling hospitals based on outcomes to improve public reporting and pay-for-performance efforts."
Maimonides Residents to Receive Bonuses for Efficiency
According to a Nov. 9 article in Crain’s New York (subscription required), medical residents at the Maimonides Medical Center in Brooklyn recently reached agreement on a new three-year contract that includes bonus payments to physicians who improve efficiency and patient care. The bonus payments will come from a pool of $750,000 and are based on measures to be negotiated between management and the hospital's 450 residents. The measures are likely to assess such factors as waiting times for the clinic, overuse of laboratory tests, and patient safety. Patterned after a similar incentive program in place for residents at the University of California San Francisco Medical Center, it is thought to be the first in the nation to be negotiated as part of collective bargaining agreement with a residents' union.
