November / December 2005
NEWS ITEMS FROM SOURCES WORLDWIDE
Pulse
The National Quality Forum (NQF) has announced publication of a new set of national consensus standards
The National Quality Forum (NQF) has announced publication of a new set of national consensus standards for home care. National Voluntary Consensus Standards for Home Health Care provides a set of standardized performance measures to facilitate comparison of the quality of home healthcare providers. The executive summary of the report, with a list of endorsed performance measures and their specifications, can be found on the NQF Web site, www.qualityforum.org.
The report details measures endorsed by NQF's more than 270 member organizations through its formal Consensus Development Process. As such, the measures have special legal standing as voluntary consensus standards. The Centers for Medicare and Medicaid Services (CMS) will report data from these measures for nearly 7,000 Medicare certified home healthcare agencies on its Home Health Compare Web site, www.medicare.gov/HHCompare.
"The old saying that 'there is no place like home' is increasingly relevant in healthcare today. More than 4 million patients currently receive home care services, and that number is steadily increasing," said Kenneth W. Kizer, MD, MPH, president and CEO of the NQF. "Improving the outcomes of care provided by the approximately 20,000 home care agencies would have significant public health benefit."
The set includes 15 measures that facilitate efforts to achieve higher levels of patient safety and better outcomes for patients. These measures are intended for public reporting. Consumers can use these publicly reported consensus standards to compare home healthcare providers to each other. Additionally, the consensus standards may be used by home healthcare providers themselves for internal benchmarking activities, to gauge where to target quality improvement projects.
The 15 measures are, in brief:
- Improvement in ambulation/locomotion
- Improvement in bathing
- Improvement in transferring
- Improvement in management of oral medications
- Improvement in pain interfering with activity
- Improvement in status of surgical wounds
- Improvement in dyspnea
- Improvement in urinary incontinence
- Increase in number of pressure ulcers
- Emergent care for wound infections, deteriorating wound status
- Emergent care for improper medication administration, medication side effects
- Emergent care for hypo/hyperglycemia
- Acute care hospitalization
- Discharge to community
- Emergent care
NQF has endorsed voluntary consensus standards that apply to a variety of care settings, including inpatient acute care hospitals, ambulatory (outpatient) care, and nursing home care. "Increasingly, the healthcare community is recognizing the benefit of standardized performance measurement and public reporting," Kizer said.
Support for this project was provided by the Centers for Medicare and Medicaid Services.
NQF is a voluntary consensus standard-setting organization. It is a private, not-for-profit, public benefit corporation established in 1999 to standardize healthcare quality measurement and reporting. Established as a unique public-private partnership, NQF has broad participation from all sectors of the healthcare industry.
Source: National Quality Forum
Codman Award Applications Available from JCAHO
The JCAHO is now accepting applications for the 10th annual Ernest Amory Codman Award. The theme for the special 10th anniversary celebration of the award is "Advancing the Dream: A Century of Progress, A Decade of Recognition, Excellence for the Millennium." This prestigious award recognizes excellence in the use of outcomes measurement by organizations and individuals to achieve improvements in the quality and safety of healthcare.
An application for the 2006 Codman Award is available online (www.jcaho.org) for more than 15,000 healthcare organizations and programs accredited or certified by the Joint Commission. The deadline for application submission is February 17, 2006. The application is also available by calling the Joint Commission's Customer Service Center at 630-792-5800.
Please call the Joint Commission's Customer Service Center at 630-792-5800, or send an email to tjohnson@jcaho.org for additional information about the Codman Award.
Source: JCAHO
Patient Safety Leadership Fellowships Applications Due in January
The Health Research & Educational Trust (HRET) and the National Patient Safety Foundation (NPSF), in partnership with Health Forum, the American Organization of Nurse Executives (AONE), the American Society for Healthcare Risk Management (ASHRM), and the Society of Hospital Medicine (SHM), are pleased to announce a unique opportunity to deepen knowledge and competencies in patient safety leadership. In its fourth year, the Patient Safety Leadership Fellowship offers a cutting-edge program and intensive learning for a select group of healthcare leaders. This innovative experience provides participants with tools and methodologies to implement strategies and practices that move their organizations' patient safety agenda forward. The business, cultural, and leadership implications and opportunities for embracing cultures of safety will be explored in depth. Upon completion of the program, Fellows will have the skills to lead safety improvement projects, culture change initiatives and long term strategic planning for safety.
Individuals may apply or nominate other colleagues who they feel would benefit from participating in this highly acclaimed program. Applications must be submitted for processing by January 10, 2006. To learn more, visit www.hretfellowships.org or call 312-422-2610.
Source: NPSF
HIMSS Advocacy Report Medical Error Disclosure and Compensation Act Introduced
On July 29, 2005, President Bush signed the first piece of patient safety legislation (P.L. 109-41) into law since the Institute of Medicine released its report in 1999 titled To Err Is Human. On September 28, Senators Hillary Rodham Clinton (D-NY) and Barack Obama (D-IL) introduced S. 1784,the Medical Error Disclosure and Compensation Act or National MEDiC Act, to promote a culture of safety within the healthcare system through the establishment of a National Medical Error Disclosure and Compensation Program. This new legislation would build upon P.L. 109-41 and provide liability protection for doctors who quickly disclose medical errors and enter into negotiations with injured patients or their families for compensation. This new legislation defines "medical error" as an "unexpected occurrence involving death or serious physical or psychological injury, or the risk of such injury, including any process variation of which recurrence may carry significant chance of a serious adverse outcome."
The Clinton/Obama legislation would create a voluntary federal program to help hospitals negotiate fair compensation with patients harmed by medical errors as an alternative to lawsuits. This legislation is not about reporting errors, but about righting a wrong with a patient, and is modeled on an initiative called "Sorry Works!" in Illinois in which hospitals own up to errors and apologize to the patients affected. Under this proposal, federal grants would be available to help hospitals set up negotiation programs, hire patient-safety experts and track patient-safety trends. The Illinois program was recently enacted by that state's legislature as part of the broader medical malpractice bill signed into law in August.
The cost of this new legislation has not been estimated by the Congressional Budget Office (CBO) yet. In addition, this newly proposed legislation would create a national medical errors database and set up an Office of Patient Safety and Healthcare Quality within the Department of Health and Human Services (HHS). This provision is similar to PL 109-41 which authorized HHS to establish a medical-errors reporting system and a national network of databases.
So how is P.L. 109-41 different from S. 1794? Specifically, the prior patient safety legislation (P.L. 109-41) tries to remove the "culture of blame" and lets stakeholders truly focus on improving patient care by learning from medical errors. In order to accomplish that goal, the current law begins by defining the following terms:
- HIPAA confidentiality regulations
- Identifiable patient safety work product
- Non-identifiable patient safety work product
- Patient safety organization
- Patient safety activities
- Patient safety evaluation system
- Patient safety work product
- Provider
Next, the current passed legislation says that patient safety work products will be privileged and not:
- Subject to federal, state or local civil, criminal or administrative subpoena
- Subject to discovery
- Subject to disclosure
- Admitted as evidence
- Admitted in a professional disciplinary proceeding
The only two primary exceptions cited in the law from privilege and confidentiality are (1) for use in a criminal proceeding after a court makes a determination that a patient safety work product contains evidence of a criminal act and (2) if authorized by the provider.
P.L. 109-41 also authorized the HHS Secretary to facilitate the "creation of, and maintain, a network of patient safety databases that provides an interactive evidence-based management resource for providers, patient safety organizations, and other entities. The network shall have the capacity to accept, aggregate across the network, and analyze non-identifiable patient safety work product voluntarily reported by patient safety organizations, providers, and other entities." Information that is reported to these new databases will be used to analyze national and regional statistics, including trends and patterns of healthcare errors.
So, the Clinton/Obama legislation goes at this problem from a different angle focused on known errors that providers admit to up front before they are reported. Until P.L. 109-41 is implemented via regulation, other overlaps will not be known. Please contact Dave Roberts, HIMSS vice president for government relations, at droberts@himss.org if you have questions about this patient safety legislation or Russell Bourke, HIMSS patient safety and quality outcomes manager, at rbourke@himss.org.
Source: Healthcare Information and Management Systems Society (HIMSS)
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