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Health Care System Performance

Two Reports Call for Health System Reform

The Commonwealth Fund's Commission on a High Performance Health System, a panel of experts from all sectors of the health care system, recently published two reports calling for transformational change in the U.S. health care system. The first, based on a nationally representative survey, found that a high proportion of Americans—42 percent—experienced poorly coordinated, inefficient, or unsafe care at some time during the past two years. The survey uncovered strong public support for efforts to improve care coordination and a shared belief that expanded use of information technology and health care teams could improve the quality of care. There was also widespread support for a fundamental overhaul of the health care system (endorsed by 75 percent of respondents). In a related report, the commission outlines its vision of a uniquely American, high performance health system. Their report charts a course for a health care system that would provide significantly expanded access, higher quality, and greater efficiency. Recommended reforms include: implementing major known quality and safety improvements; expanding the use of information technology; rewarding performance for quality and efficiency through payment systems; increasing public reporting on quality and costs; and expanding health insurance coverage.

Scorecard: Health System Gets Barely Passing Grade
This month, the Commonwealth Fund Commission on a High Performance Health System published a scorecard on U.S. health system performance. The scorecard provides benchmarks for the nation based on standards that have been achieved in certain U.S. hospitals, health systems, and regions as well as in other countries. The nation as a whole earned an overall grade of 66 out of 100. The first in a series, the scorecard is intended to provide a mechanism for monitoring change over time across the core health system goals of quality, access, efficiency, and equity. It draws on a body of evidence, including seminal reports from the Institute of Medicine and national and cross-national research studies, indicating the health system falls short, given the high level of resources committed to it. Not only is the United States the only industrialized country that fails to guarantee universal health coverage, but the quality of care Americans receive is highly variable and delivered by a system that is too often poorly coordinated—driving up costs and putting patients at risk.


Demo Finds P4P Could Save Lives, Reduce Costs
Widespread adoption of quality measures by U.S. hospitals would save lives, reduce complications of care, and lower costs, according to a pay-for-performance (P4P) demonstration program led by Premier Inc., an alliance of nonprofit hospitals, and the Centers for Medicare and Medicaid Services. According to an analysis by Premier Inc., if all pneumonia, heart bypass, heart attack, and hip and knee replacement patients received most or all of a set of care processes in 2004, it could have resulted in nearly 5,700 fewer deaths, 8,100 fewer complications, 10,000 fewer readmissions, and 750,000 fewer days in the hospital. In addition, hospital costs could have been as much as $1.35 billion lower. The analysis drew on 33 indicators of quality care from 250 hospitals across the country. The demonstration project, which began in 2003, will continue to test whether financial incentives are effective at improving the quality of inpatient hospital care.

Private P4P Programs Growing in Number, Diversity
Growing numbers of private health plans are implementing pay-for-performance programs, according to a recent study published in the American Journal of Managed Care. But according to the researchers, there is substantial variation in the design of the programs within and across markets. Providers are concerned that the varying measures will create administrative burdens and conflicting financial incentives. While standardization across health plans might address such concerns, it might also hamper local collaboration among plans and providers.

Error Identification and Prevention

IOM: Medication Errors Harm 1.5 Million a Year
According to a recent report from the Institute of Medicine (IOM), medication errors are surprisingly common, leading to 1.5 million preventable adverse drug events each year—much more than previously estimated. The study found that drug-related errors are the most common type of medical error, occurring at the time of prescribing through to the monitoring of patients' responses. Error rates are high in hospitals, as well as in long-term care settings and outpatient facilities. The costs of treating drug-related injuries occurring in hospitals alone amount to $3.5 billion a year. To reduce errors, the IOM committee recommends steps to improve interactions between health care professionals and patients. The report also calls for the creation of resources through which patients can obtain objective, easy-to-understand information about prescription drugs.

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