Secure, Online Personal Health Record Available to Every American at No Cost

An unprecedented coalition of national healthcare leaders have "flipped an electronic switch," launching a secure, interactive, personal health record for every American. The iHealthRecord permits Americans to take control of their personal health as never before. Beyond housing personal health data for use by physicians or emergency departments — including current medical conditions, medications, past surgeries, and allergies, as well as end-of-life directives — the standards-based iHealthRecord provides a suite of unique services to increase medication adherence, enhance continuity of care, and improve patient-physician communication. Patients receive education programs specific to their medical conditions, automated reminders regarding their medications and conditions, as well as FDA-related safety warnings and recalls.

The iHealthRecord patient education programs are developed in conjunction with leading U.S. medical societies, the American Heart Association, American Cancer Society, CDC, FDA, and other national experts. The iHealthRecord is the result of a multi-year effort led by Medem, the nation's premier physician-patient communication network, founded by leading U.S. medical societies, including the American Medical Association. "The AMA is committed to improving patient safety, enhancing healthcare quality, and strengthening the patient-physician bond through the use of appropriate technology," stated J. James Rohack, MD, chairman of the American Medical Association. "We believe that electronic personal health records are an important service for physicians and patients, and a key element of the national IT infrastructure."

Source: www.ihealthrecord.org

Medical-Errors Gap Widens Between Best and Worst Hospitals: HealthGrades Study

Patient safety incidents at America's hospitals increased slightly, but the nation's safest hospitals grew even safer, resulting in a wider gap in patient safety incident rates among the nation's best and worst hospitals, according to a new study of 37 million patient records released in May by HealthGrades, an organization that evaluates the quality of hospitals, physicians, and nursing homes for consumers, corporations, hospitals, and health plans.

The second annual HealthGrades Patient Safety in American Hospitals Study finds that 1.18 million patient safety incidents occurred among Medicare hospitalizations in the years 2001, 2002, and 2003, with the cost to Medicare approaching $3 billion annually. That compares with 1.14 million incidents in the three years beginning with 2000. The study also finds that hospital-acquired infections grew by 20% and accounted for 30% of the costs of patient safety incidents.

"The reason we see the hospitals with the lowest incident rates improving the fastest is that they have what I call a 'culture of safety'," said HealthGrades Vice President of Medical Affairs Samantha Collier, MD, who authored the study. "A 'culture of safety' requires rapid identification of errors and root causes and the successful implementation of improvement strategies, which can only be achieved with strong leadership, critical thinking, and commitment to excellence. For patients, it's important to know which hospitals meet this standard, as they are nearly 200% less likely to have an incident at hospitals in the top 10%, according to the HealthGrades study."

The study, which applies 13 patient safety indicators (PSIs) identified by the Agency for Healthcare Research and Quality (AHRQ) to Medicare hospitalizations, produced the following findings:

• There were wide, highly significant gaps in individual PSI and overall performance between the top10% and the bottom 10% ranked hospitals.
  
• Top 10% hospitals generally had lower incident rates across all PSIs in 2001, but also generally improved at a greater rate than the bottom 10% hospitals between 2001 and 2003.
  
• Overall, from 2001 through 2003, the best-performing hospitals as a group (hospitals that had the lowest overall PSI incident rates of all hospitals studied, defined as the top 10% of all hospitals studied) had 267,151 fewer patient safety incidents and 48,417 fewer deaths resulting in a lower cost of $2.3 billion associated with Medicare beneficiaries as compared to the bottom 10% of all hospitals studied.
  
• Patients in the top 10% hospitals had, on average, an almost 200% lower occurrence of experiencing one or more PSIs compared to patients at the bottom 10% hospitals. Important and frequent contributors to this notable difference were significantly lower rates of hospital-acquired infections and post-operative metabolic derangements.
  
• If the bottom 10% hospitals improved only their hospital-acquired infection rates to the level of top 10% hospitals, 2,734 deaths associated with $792 million could have been avoided from 2001 through 2003.
  
• Of the total of 302,541 deaths among patients who developed one or more PSIs during 2001 through 2003, 81% (n=245,008) of these deaths were attributable to the patient safety incidents.
  
• Hospital-acquired infections correlated most highly with overall performance and performance on the other 12 PSIs, suggesting that hospital-acquired infection rates could be possibly used as a proxy of overall hospital patient safety.
  
• Hospital-acquired infections rates worsened by approximately 20% from 2000 to 2003 and accounted for 9,552 deaths and $2.60 billion, almost 30% of the total excess cost related to the patient safety incidents.

ÝThe complete study and methodology can be found at http://www.healthgrades.com.

Source: www.healthgrades.com

Four in 10 Seniors Do Not Take Medications as Prescribed; Poor Experiences with Drugs and Costs Contribute to Non-Adherence

Four in 10 seniors told researchers in a recent national survey that they haven't taken all the drugs their doctors prescribed for them in the past year — either because the costs were too high, because they didn't think the drugs were helping them, or because they didn't think they needed them. The survey of 17,685 seniors was conducted by the Kaiser Family Foundation, The Commonwealth Fund, and Tufts—New England Medical Center.

The survey reveals that many seniors deal with complex and costly drug regimens. Of the 89% of seniors who report taking prescription drugs in the past year, nearly half (46%) take five or more, more than half (54%) have more than one doctor who prescribes medicine, and about a third (35%) use more than one pharmacy. Among seniors with at least three chronic health conditions, nearly three of four (73%) take five or more medications regularly, and more than half (52%) do not take all their drugs as prescribed.

"With two out of five seniors not taking medicines as prescribed, there is a real opportunity to improve patient care both by urging doctors and patients to talk more about these issues and by developing systems to monitor quality and safety," said Commonwealth Fund President Karen Davis, PhD. "These steps are an important complement to the new Medicare prescription drug coverage."

"The substantial variations in drug coverage across states documented in this survey suggest that targeted outreach efforts have the best chance of reaching seniors," said Kaiser Family Foundation President Drew E. Altman, PhD.

An article published online by the journal Health Affairs features results from the 2003 national survey of Medicare beneficiaries 65 and older. The survey was conducted prior to the enactment of the Medicare Modernization Act and included a representative national sample with oversampling from 12 states — California, Colorado, Florida, Illinois, Louisiana, Michigan, New York, Ohio, Pennsylvania, Texas, Tennessee, and Washington. Dana Gelb Safran, ScD, who directs The Health Institute at Tufts-New England Medical Center, led the research team.

Nationally, slightly more than one in four seniors (27%) reported that they did not have any prescription drug coverage at the time of the survey. Coverage rates varied widely across states, with seniors in Louisiana (35%) and Washington (36%) more than twice as likely to lack coverage than seniors in New York (16%). Among low-income seniors (those with incomes less than twice the federal poverty level) nationwide, one-third lacked coverage — and in several states, including Ohio, Louisiana, Texas, and Washington, more than 40% of low-income seniors lacked coverage.

"Drug costs have been a major concern for seniors. The new Medicare drug benefit, coupled with the low-income subsidies, presents a real opportunity to get seniors the help they need," Dr. Safran said. "The challenge will be getting seniors the information they need to make good enrollment decisions and ensuring that low-income seniors take advantage of the subsidies available to them."

Seniors were about as likely to cite their experiences with their medications as a reason for not taking their medications as prescribed as they were to cite the cost of their drugs, with 25% saying they skipped doses or stopped taking a drug because it made them feel worse or wasn't helping, and 26% saying that they did not fill a prescription, skipped doses, or took smaller doses due to cost reasons.

Drug coverage made a substantial difference in adherence rates, with 37% of seniors without drug coverage reporting cost-related non-adherence, compared with 22% of seniors with drug coverage. Low-income seniors without drug coverage generally took fewer drugs than those with drug coverage.

Seniors also reported wide differences in the source of their drug coverage across states. For example, nationally 29% of seniors reported having employer-sponsored drug coverage, but state rates for employer-sponsored drug coverage ranged from 24% in Washington to 47% in Michigan.

The survey also asked about obtaining drugs from other countries. Overall, one in 20 seniors (5%) reported having obtained prescription drugs from pharmacies in Canada or Mexico. These rates varied across the 12 states, from a high of 11% in Washington to a low of 2% in New York. Seniors without drug coverage were more likely to obtain drugs from Canada or Mexico. Nationally 11% of seniors without drug coverage reported obtaining from one of those nations, with the state levels ranging from 19% in Colorado to 5% in Tennessee.

The article, "Prescription Drug Coverage and Seniors: Findings from a 2003 National Survey," and several additional exhibits, including state-specific data, are available at http://www.kff.org/medicare/med041905pkg.cfm and www.cmwf.org.

Source: www.cmwf.org

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