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Disclosure of Patient Satisfaction Data Linked to Improvement
Last month, the survey and consulting firm Press Ganey published research showing that—since the Centers for Medicare and Medicaid Services (CMS) began publishing hospital-specific patient satisfaction scores—these scores have dramatically improved. This finding helps to make the case that public disclosure of such scores can spur hospitals to take action to improve patient care.

The report evaluated the experiences of 1.5 million patients in 1,158 hospitals across the nation, from January 2007 through June 2008, using Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) data.

After the first public release of HCAHPS data in March 2008, there was a positive increase from the previous years' performance in April, followed by statistically significant year-over-year increases in May and June. These increases were seen both in the percentage of patients rating their hospital as a 9 or 10 (out of 10), as well as the percentage of patients who said they would definitely recommend the facility to others.

"We have always seen a slow and steady improvement in patient-centered care over the years," says Deirdre Mylod, M.D., vice president of acute services at Press Ganey, which has evaluated patient satisfaction trends for 23 years. "The HCAHPS measures show a dramatic increase … following the public reporting which indicates that everyone really stepped up their efforts—and the results are astounding."

HealthGrades Report: Mortality Rates Decline, But Significant Variation Persists
Hospital mortality rates improved from 2005 to 2007 by 14 percent across the nation, according to a study published last month by HealthGrades, an independent ratings organization. Still, the study found widely varying mortality rates among states, regions, and individual hospitals; patients had a 70 percent lower change of dying at top-rated hospitals compared with lowest-rated hospitals.

The report was based on an analysis of 41 million Medicare patient records from about 5,000 hospitals. It examined 17 procedures and conditions, including heart failure, sepsis, pneumonia, and respiratory failure—four conditions that together accounted more than half of the potentially preventable deaths.

Hospitals were assigned quality ratings from best to worst—five, three, and one stars—based on risk-adjusted mortality and complication rates. According to this analysis, mortality rates at five-star hospitals declined by 14.7 percent between 2005 and 2007, compared with decreases of 13.1 percent and 12.3 percent at three-star hospitals and one-star hospitals, respectively. Researchers estimate that 237,420 Medicare beneficiaries' lives could have been saved from 2005 to 2007 if every hospital had performed at a five-star level.

The Upper Midwest—Illinois, Indiana, Michigan, Ohio, and Wisconsin—had the lowest risk-adjusted mortality rates, while Alabama, Kentucky, Mississippi, and Tennessee had the highest. The greatest regional variation in mortality rates by condition was seen for heart failure, pulmonary, stroke, and cardiac surgery.

Remote Monitoring of Chronic Diseases Could Save Billions, Report Finds
A report published last month found that using technology to remotely monitor patients with chronic conditions could reduce health care costs by as much as $197 billion over the next 25 years.

The report, by the economist Robert Litan, vice president of research and policy at the Kauffman Foundation and a senior fellow at the Brookings Institution, was funded by AT&T and Better Health Care Together, a nonprofit consortium that promotes health care reform. It analyzed the potential effects of vital sign remote monitoring for patients with chronic skin ulcers, chronic obstructive pulmonary disease, heart failure, and diabetes.

The potential savings would come from reduced emergency department visits as well as fewer and shorter hospitalizations. Remote monitoring could also improve patients' health outcomes and their quality of life. "Remote monitoring can spot health problems sooner, reduce hospitalization, improve life quality, and save money," Litan concludes.

To realize the full potential of remote chronic care management, broadband technology would have to be more widely deployed and health care purchasers would need to reimburse providers for the service. In addition, standards for privacy, liability, and interoperable systems would have to be established.

Unique Patient Identifiers Would Improve Safety, Efficiency of Care
A RAND Corporation study published last month concluded that the creation of unique patient identifiers (UPIs) would reduce medical errors, simplify use of electronic medical records, increase health system efficiency, and protect patient privacy. UPIs are conceived of as unique identifiers that would follow individuals throughout their lives and be used only for health records.

Federal legislation passed a decade ago supported the creation of UPIs, but concerns over patients' privacy have hindered efforts to make them a reality.

According to the researchers, creating a nationwide UPI system would cost $11 billion, but these costs could be offset by the savings from greater health system efficiency, estimated to be about $77 billion annually. UPIs would enable physicians, hospitals, and other authorized users to easily and reliably share patients' clinical and administrative records.

Most health systems currently identify patients using a technique known as statistical matching, which retrieves a patient's medical record by searching for attributes such as name, birth date, address, gender, medical record numbers, and Social Security Number. Based on a review of previous studies, RAND researchers estimated that statistical matching returns incomplete medical records about 8 percent of the time. In addition, this technique leaves room for error, because the information used to identify patients may not be unique to an individual, may change over time, and may be entered in varying formats in different databases.

The study also concluded that UPIs would not threaten patients' privacy or the security of their health information, as security and privacy in a networked health information system have more to do with how access is managed and records maintained than with the specific identifier approach. UPIs could actually help to strengthen security, the researchers say, since UPIs would become protected information under federal and state laws.

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