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Patients To Have Their Say on Hospital Compare
Later this month, the federal health care quality reporting Web site, Hospital Compare, will expand to include patients' views on their care. Hospital Compare currently reports how often hospitals provide evidence-based care to patients for certain conditions, as well as mortality data.

Findings from the Hospital Consumer Assessment of Healthcare Providers and Systems, the first standardized survey of hospital patients, will be posted on Hospital Compare, enabling comparisons between facilities based on patients' perspectives. The survey includes questions about the communication skills of physicians and nurses, pain control, and the quality of discharge instructions. Hospitals that do not report the results of the 27-question survey stand to lose 2 percent of their Medicare reimbursement.

AHRQ Report: Health Care Quality Improvements Slowed, Costs Increased
Health care costs are rising at a faster rate than that of quality improvement nationwide, according to the fifth annual National Healthcare Quality Report, released by the Agency for Healthcare Research and Quality (AHRQ) early this month.

The report found a modest improvement in quality from 1994 to 2005, on average about 2.3 percent each year. This rate has slowed from an average of 3.1 percent annual improvement documented from 1994 to 2004. (AHRQ is mandated by Congress to track U.S. health system performance on 41 measures of the effectiveness, timeliness, safety, and patient-centeredness of care.) In comparison, health care expenditures rose by an average rate of 6.7 percent per year from 1994 to 2005.

Still, the report identified several areas of improvement in quality. For example, more than 93 percent of hospitalized heart attack patients received recommended care in 2005, up from about 77 percent in 2000–2001. The percent of heart attack patients who were counseled to quit smoking also increased, from 43 percent in 2000–2001 to about 91 percent in 2005.

A companion report on health care disparities related to race, ethnicity, and income found some evidence of progress. However, black children are still 3.8 times more likely than white children to be hospitalized for asthma, and new AIDS cases are 3.5 times more common among Hispanics than whites.

Survey: Health Data Exchange Tops States' Priorities
Most states are promoting the use of health information technology (HIT) in both the public and private sectors as a way to improve the quality and efficiency of care, according to the results of a new survey.

Jointly sponsored by The Commonwealth Fund, National Governors Association, and Health Management Associates, the survey asked states about their current HIT activities, the challenges they have faced, and opportunities for further development.

According to the survey, state governors' two highest priorities for the next two years are the development of electronic health information exchanges and the creation of policies fostering such exchanges, to ensure interconnectivity among health care providers. They cited funding as the biggest barrier to implementing these initiatives.

Michigan Hospitals Can Continue Using Infection-Control Checklist
Last month, the U.S. Department of Health and Human Service (HHS) Office for Human Research Protections (OHRP) announced that Michigan hospitals may continue using a checklist aimed at cutting the rate of catheter-related infections in intensive care units. Last year, OHRP had said that the use of the checklist—which reminds physicians to wash their hands and take other steps to avoid infections—should be subject to regulations governing human subjects research. Because the hospitals did not obtain written, informed consent from each patient and health care provider, the agency concluded that the quality improvement intervention violated the federal regulations.

In its February 15 announcement, OHRP stated that the regulations governing human subjects research apply only when institutions are planning research activities examining the effectiveness of interventions to improve the quality of care—not when they are implementing proven practices to improve the quality of care. In this case, the results of the intervention had already been published in a December 2006 New England Journal of Medicine article.

Noting that they do "not want to stand in the way of quality improvement activities that pose minimal risks to subjects," agency officials say that HHS will review its application of human subject research regulations to evidence-based quality improvement initiatives.

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