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March / April 2006
NEWS ITEMS FROM SOURCES WORLDWIDE
Pulse
NQF Releases Standardized Patient Safety Classification System
The nation's battle against medical errors, which are among the top 10 causes of death in the United States, received a significant boost recently when the National Quality Forum (NQF) released a report with the first ever nationally standardized, consensus framework for classifying patient safety data.
To improve the safety of healthcare, U.S. healthcare providers and regulators need better information. Hundreds of entities, including federal and state agencies, insurance companies, and individual healthcare providers, collect information about healthcare safety — including details of instances in which patient safety is endangered. Pressure to collect, understand, and learn from patient safety data is growing, encouraged by a burgeoning healthcare consumerism movement and by a new federal law, the Patient Safety and Quality Improvement Act of 2005. Such data will not be useful, however, until they are standardized, aggregated, and analyzed.
The lack of a single, standardized format for amassing these data has been a major barrier to a broader understanding of patient safety problems. The NQF report rectifies this by endorsing a standardized classification instrument, known as a "patient safety taxonomy." The NQF-endorsed Patient Safety Event Taxonomy (PSET) provides a structure to categorize and analyze occurrences that threaten patient safety (i.e., any risk, event, error, hazardous condition, or set of circumstances that has harmed or could harm patients). NQF endorsed PSET, which was developed by the Joint Commission on Accreditation of Healthcare Organizations, in August 2005, granting it special legal status as a voluntary consensus standard.
"Making healthcare safer by reducing errors is among our highest priorities in the effort to improve healthcare quality," said Robyn Y. Nishimi, Ph.D., interim chief executive officer of NQF. "We have to begin systematically analyzing safety problems, and we have to do it at system and nationwide levels if we want to make significant strides in improving patient safety. This report represents a needed step to gather better data to improve healthcare safety."
"When broadly and properly used, PSET has the potential to be a powerful tool for improving patient safety," says Dennis S. O'Leary, M.D., president of the Joint Commission. "We are excited to see PSET moving forward in the United States and as a platform for development of an international taxonomy by the World Health Organization as well. Both here and abroad, we see great opportunities and benefits in weaving together the multiple other taxonomy efforts already underway."
Healthcare leaders expect the NQF-endorsed PSET to enable interoperability of reporting systems and comparability of information across systems and over time. The Joint Commission developed PSET with the assistance of a work group comprising representatives of provider and health professional organizations and the federal government. Like all NQF-endorsed standards, PSET is open source. The executive summary and portions of the report are available on the web at www.qualityforum.org.
Source: www.qualityforum.org
Largest Medical Board and Leading Healthcare Purchaser Team Up for Quality Incentive Program
In the first collaboration of its kind, an influential private sector purchaser and the organization that certifies the largest medical specialty in the United States have joined together to advance a new program to measure, report, and reward physicians for high quality health care. This program, developed by the American Board of Internal Medicine (ABIM) with support from Bridges to Excellence (BTE), would result in a decreased burden of quality data reporting for physicians while delivering to employers and health plans the broadest set of physician-developed quality measurements to-date to help them recognize and pay bonuses to eligible internists.
The new ABIM program, the Comprehensive Care Practice Improvement Module, would allow as many as 180,000 internists who seek to maintain ABIM board certification to send their performance data collected through that process to BTE and eventually to other payers. BTE is a multi-stakeholder organization whose programs recognize and reward physicians who effectively manage patients. Under this new partnership with ABIM, to take effect with the introduction of the product expected in late 2006, participating internists would qualify for maintenance of board certification, continuing medical education credits, and bonus payments under BTE's new Internal Medicine Care Link.
Sponsors say this effort goes well beyond what any plan can measure today through claims data. "With 60 measures of clinical process and outcomes, robust measurement of practice systems, and patient feedback on personal experience, this program will give physicians the opportunity to see on a broad scale how they are doing in practice and where quality improvement needs to occur," says BTE President Dale Whitney, corporate health manager for UPS.
"Doctors would spend less time reporting because data would be collected once but used for multiple purposes," says ABIM President and CEO Christine Cassel, M.D. "This is an important step not only toward aligning incentives, but to reducing wasted effort, which drives up costs in our system," she says.
Working with an expert outside advisory committee and relying on an analysis of empirical data, ABIM will select measures that have met national standards and define if and how performance thresholds can be rigorously and reliably set. BTE will set payment levels and receive guidance from Towers Perrin as it establishes those thresholds. ABIM also will incorporate an audit mechanism to assure data veracity.
ABIM will provide BTE with a summary assessment of overall internist performance that will include information on a variety of measures: clinical performance related to treatment of asthma, diabetes, and other chronic conditions; practice infrastructure, examining such things as care management systems and information management/technology capacity; and patient survey data.Ý
Although participation is voluntary, BTE's Whitney thinks physicians will be motivated to participate given the program design and incentives. "Physicians are looking for good data on how they can improve care — they just want it to be easy to use and not complicate their practice. They are already committed to improving care — if they get rewarded for doing it, so much the better."
The Bridges to Excellence coalition is a not-for-profit organization created to encourage significant leaps in the quality of care by recognizing and rewarding health care providers who demonstrate that they deliver safe, timely, effective, efficient, and patient-centered care. Bridges to Excellence participants include large employers, health plans, the National Committee for Quality Assurance, MEDSTAT, and WebMD Health, among others. The organizations are united in their shared goal of improving health care quality through measurement, reporting, rewards, and education.
Source: www.bridgestoexcellence.org
Study: Hospitals Rated in Top 5% Have Mortality Rates 27% Lower
Patients checking into a hospital rated in the top 5% in the country have, on average, a 27% lower chance of mortality and a 14 % lower risk of complications, according to a study released today by HealthGrades, the leading independent healthcare ratings company. The annual HealthGrades study identifies hospitals in the top 5% in the nation in terms of mortality and complication rates across 26 procedures and diagnoses, from bypass surgery to hip-replacement surgery.
The study finds that 152,966 lives could have been saved, and 21,896 complications could have been avoided, if the quality of care at all hospitals matched the level of those in the top 5%.
To name hospitals in the top 5% for clinical excellence, HealthGrades' fourth annual Hospital Quality and Clinical Excellence study analyzes nearly 39 million hospitalizations over the years 2002, 2003, and 2004 at all 5,122 of the nation's nonfederal hospitals. Those with the lowest mortality and complication rates are named Distinguished Hospitals for Clinical Excellence.
"The data in this year's study indicate a clear and profound divergence between the best hospitals and all others," said Samantha Collier, MD, HealthGrades' vice president of medical affairs. "HealthGrades applauds those hospitals that have operationalized excellence, ensuring that high-quality care is delivered not just in one or two categories of care, but across the board, from cardiac care to orthopedic surgery. But this growing 'quality chasm' is of concern to healthcare professionals and patients alike, and we urge all consumers, if possible, to do their homework before checking into a hospital."
Individuals may see how their local hospitals are rated, and if they have been designated Distinguished Hospitals for Clinical Excellence, for free at www.healthgrades.com.
In its 2006 study, HealthGrades independently and objectively analyzed millions of Medicare patient records from fiscal years 2002, 2003 and 2004, for 26 medical procedures and diagnoses. To qualify for the list, hospitals were required to meet minimum thresholds in terms of patient volumes, quality ratings and the range of services provided. Prior to comparing the mortality and complication rates of the nation's hospitals, HealthGrades risk-adjusted the data, to compare on equal footing hospitals that treated sicker patients. Hospitals with risk-adjusted mortality and complication rates that scored in the top 5% or better nationally — which demonstrates superior overall clinical performance — were then recognized as Distinguished Hospitals for Clinical Excellence. HealthGrades' methodology is open and can be found in the study and on the company's Web site.
Source: www.healthgrades.com
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