Fla. hospitals make little progress on error reduction
Filed under: Government, Health care reform, Health policy, Hospitals, Hot Health Headline, Studies
South Florida Sun Sentinel reporters Sally Kestin and Bob LaMendola report that, despite the myriad initiatives and protocols launched in the dozen years since a landmark report thrust medical errors into the headlines, little progress has been made in actually reducing the toll taken by medical errors.
“I don’t really see any improvement in patient safety,” said Dr. Arthur Palamara, a Hollywood vascular surgeon and advocate for safer practices. “Unfortunately, despite all the protocols that were put in place, the adverse incidents, the wrong-site surgeries still keep happening at the same rate.”
A long list of technological advances and a national emphasis on preventing mistakes “hasn’t made a difference,” said Douglas Dotan, chief executive of CRG Medical, a Houston firm that sets up error-prevention systems…
They found that, while some progress has been made, even the most aggressive hospitals have found it difficult to crack the exceeding complex web of human and mechanical interactions that make errors possible.
These findings, which have become a depressingly predictable event, are built in part on research published in the April, 2011 issue of Health Affairs, a publication to which AHCJ members are granted free access.
AHCJ resources on patient safety
- Health Journalism 2008: Dennis Quaid acts on medical errors
- Health Journalism 2010: Patient safety expert Peter Pronovost, M.D., Ph.D., of Johns Hopkins University was the keynote speaker.Watch an excerpt of his address and see his PowerPoint presentation.
- Deciphering hospital quality data
- Public handicapped by lack of information on medical errors
- Medical errors and the movement toward transparency
- Sunshine Week: Some hospital quality measures online but more could be done
- Hospital patient safety initiatives borrow from transportation industry
- Outsourcing of pharmacies: Prescription for problems?
- Medical misconnections: Patient-safety problems
- Reporter documents surgical errors through public records
Minority population swells in nursing homes
Filed under: Aging, Health data, Hot Health Headline, Public health, Tools
In The Providence Journal, reporter and AHCJ board member Felice Freyer reports on the local effects of the national trend toward higher proportions of minority residents in nursing homes. In addition to the logistical concerns raised by this demographic shift, Freyer also explores what it says about health disparities and access to care in minority communities.
Freyer’s report is built on a Brown University study published in the July edition of Health Affairs. As you may know, free access to Health Affairs is one of the many benefits that come with your AHCJ membership.
… between 1999 and 2008, the number of Hispanics and Asians living in U.S. nursing homes grew by 54.9 percent and 54.1 percent, respectively, while the number of whites dropped 10.2 percent.
These numbers reflect the changing demographic profile of elderly people, whose ranks include growing numbers of blacks, Hispanics and Asians. But the researchers say their findings also raise questions about whether minority-group members have poorer access to assisted-living and community-based care. The question may be especially relevant as states such as Rhode Island strive to “rebalance” the long-term system to favor home-based care over institutional care.
Freyer’s story also includes data from Brown’s LTCfocus.org site, a handy tool for sorting and visualizing data related to long term care and nursing homes.
Spotlight on health care quality, measures
Filed under: Health policy, Public health, Studies
The April issue of Health Affairs focuses on the quality of health care in the United States. Some highlights of the issue, which was sponsored by the Robert Wood Johnson Foundation:
- analysis and commentary on improving performance measures
- research that found the methods currently used to gauge patient safety actually missed 90 percent of the adverse events
- the cost of errors and adverse events
- research on measuring quality
- lessons to be learned from other countries
- how pay-for-performance has affected quality
- several case studies of how quality has improved in specific institutions
Those of you who attended Health Journalism 2010 might be particularly interested in an update from Peter J. Pronovost, M.D., who was the keynote speaker at last year’s conference. In this issue of Health Affairs, Pronovost writes about the advances in reducing central line-associated bloodstream infections – which he discussed at last year’s talk.
Remember, AHCJ members receive free access to Health Affairs. If you haven’t already signed up for access, be sure you take advantage of that benefit.
Video, presentations from comparative effectiveness conference available online
Filed under: Government, Health care reform, Health data, Public health, Studies, Tools
Earlier this month, ECRI’s 17th annual conference tackled the thorniest detail of comparative effectiveness research, namely that it’s rarely a simple matter of A > B. Groups and individuals respond differently.
With a theme of “Comparative Effectiveness and Personalized Medicine,” the nonprofit and its partners at NIH and Health Affairs, among others, sought to better understand how big research ideas will interface with the person-by-person decisions through which such work will ultimately be implemented.
The conference has a detailed postmortem online, including two days of video (Fair warning: Together, they’re a good 700+ minutes of conference) and slides from a number of the presentations. I strongly recommend using the conference schedule listed on the slides page as a rough guide to finding the most relevant bits of video.
In case you’re looking for a place to start, here are two of the most relevant presentations:
- Keeping the comparative effectiveness debate rational
- Comparative effectiveness research in the Veterans Health Administration (and in Kaiser Permanente, which references patient preference and participation)
The online Q and A is also interesting, though there are only a handful of answers up at present. The most relevant one so far comes from Vivian Coates (Vice President, Information Services and Health Technology Assessment, ECRI Institute), in response to a query about a central listing of comparative effectiveness projects.
The CER inventory contract was awarded to the Lewin Group Center for Comparative Effectiveness Research (CER) in June, 2010. Over the 27 month period of the contract, Lewin will design, build and launch a web-based inventory that catalogs CER outputs and activity, including research studies, relevant research methods, training of researchers, data infrastructure and approaches for dissemination and translation of comparative effectiveness research to health care providers and patients.
Is America’s high health spending linked to short lifespans?
Filed under: Europe, Government, Health care reform, Health policy, Member news, Public health, Public records, Studies
The United States lags behind other developed nations in life expectancy, yet spends far more on health care than any other nation. This is not news. Now if someone could definitively tell us why, that would be news. Life expectancy’s a dangerously blunt measure of the efficacy of a nation’s health care system, as there more confounding factors than anyone can possibly account for.
Neverthless, Columbia-affiliated public health researchers publishing in the latest edition of Health Affairs (free to AHCJ members!) have taken a stab at it, doing their best to tease out the biggest confounds and determine why Americans don’t live as long as their counterparts in the other 12 large, historically developed nations, all of which happen to provide universal health care of one variety or another. The paper looked at 15-year survival rates for 45- and 65-year-olds, in order to avoid the confusion introduced into life-span statistics by each country’s different reproductive (and end-of-life) policies. It’s a little complicated, so I’ll let the authors explain:
In this paper we explore changes in fifteen-year survival at middle and older ages, alongside per capita health care spending, in the United States and twelve other wealthy nations. We then examine the extent to which the survival and cost variations over time among these nations can be explained by demographics, obesity, smoking, or mortality events that are not closely related to health care, such as traffic accidents and homicide. By comparing health system costs and mortality rates over time, it is possible to assess whether trends in risk factors for health or causes of death can explain the observed relative decline in broad health outcomes among American men and women over the past thirty years.
As it turns out, those risk factors don’t appear to explain anything. In the 30 years between 1975 and 2005, the American system has weakened relative to equivalent countries despite the fact that smoking rates declined, obesity rates grew more slowly than they did overall in the other 12 nations and accident and homicide rates remained the same. So, while risk factors stayed steady (or improved), America continued spending more and getting less in return.
The researchers didn’t come up with a perfect explanation, of course, but they have their suspicions. On the Health Affairs blog, Chris Fleming summarizes their conclusion:
Rising health spending itself, the authors conclude, might be responsible for the relative decline in survival. They cite three consequences of rising health spending: an increase in the number of people with inadequate health insurance; the inability to allocate financial resources to life-saving programs; and unregulated fee-for-service reimbursement and an emphasis on specialty care that leads to unneeded procedures and fragmented care. As a result, they conclude, “meaningful reform may not only save money over the long term: it may also save lives.”
In addition to lives, checklists save money
Filed under: Health data, Health policy, Hot Health Headline, Studies
Last year, Atul Gawande and company made a splash by showing what a profound clinical impact checklists made on patient outcomes. Now they’re back, but this time the checklist evangelists are aiming for the pocket book. In the latest Health Affairs, Gawande and seven others contributed a paper with the descriptive title “Adopting A Surgical Safety Checklist Could Save Money And Improve The Quality Of Care In U.S. Hospitals.”
Photo by cybrjoe via FlickrHere’s their arithmetic, courtesy of The Boston Globe’s Elizabeth Cooney
Time was the biggest cost in setting up the checklist, Gawande and his co-authors write in the journal Health Affairs. They estimated that a hospital with at least a 3 percent rate of complications per year would begin to see savings after five major complications were prevented. That means a hospital where 4,000 noncardiac operations were done each year could save about $25 on each procedure, or about $100,000 annually, they concluded.
As always, free access to Health Affairs studies is one of many perks enjoyed by AHCJ members.
Assessing acute care in America
Filed under: Health care reform, Health data, Hospitals, Hot Health Headline
The New York Times‘ Kevin Sack reports on a Health Affairs study that explores “acute medical care,” particularly initial visits for the fever and cough type of stuff that would traditionally go to a primary care physician. While 42 percent of such visits were still handled by a patient’s personal physician, a full 28 percent took place in emergency rooms. According to Sack, that number includes almost all visits made outside of typical office hours, as well as most visits made by patients without insurance.
More than half of acute care visits made by patients without health insurance were to emergency rooms, which are required by federal law to screen any patient who arrives there and treat those deemed in serious jeopardy. Not only does that pose a heavy workload and financial burden on hospitals, but it means that basic care is being provided in a needlessly expensive setting, often after long waits and with little access to follow-up treatment.
Reform provisions such as medical homes, accountable care organizations and more money for primary care seek to rebalance acute care delivery in the United States, but Sack reports that the study’s authors fear it won’t be enough.
The authors warn that it might not be enough. “If history is any guide, things might not go as planned,” they wrote. “If primary care lags behind rising demand, patients will seek care elsewhere.”
Remember, free access to Health Affairs is one of many perks enjoyed by AHCJ members.
How reform will affect America, group by group
Filed under: Health care reform, Health policy, Hot Health Headline, Studies
In Health Affairs (AHCJ members get free access), economist Joseph Newhouse considers how health care reform will affect four major groups. They’re summarized below.
- Uninsured or on Medicaid or CHIP (30 percent)
- Insured individually or through a small business (10 percent)
- Insured through a mid-size or large business (45 percent)
- Recipient of Medicare (15 percent)
Medicaid expansion and broader subsidies are “major gains.”
This group will undergo the most change, with the individual mandate expanding their ranks to as much as 50 million people (16 percent of Americans). Health reform should “repair” this now-broken sector of the market.
A wash, as an insurance tax is balanced out by a reduced need to cover uncompensated care for the uninsured.
Complicated. The doughnut hole will close, but future financing sources are murky. Newhouse goes pretty deep into just how murky.
His conclusion is relatively upbeat. Newhouse writes that while reform “addressed many issues in health care financing, it left many others unresolved.” The system will need to be revised and updated throughout the foreseeable future, Newhouse writes, and effective implementation will “require persistence for many years to come.”
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Join us in Atlanta
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Fellowship applications
due Feb. 27
New at HealthJournalism.org
- Data gives depth to investigation of patient safety
- What reporters should know about Alzheimer’s and related dementias
- Apply for fellowships to attend Health Journalism 2012
- AHCJ asks Supreme Court to permit broadcast of arguments in health reform case
- Tips for print, online journalists to embrace broadcast opportunities
- Numbers reveal how often, or how rarely, states check doctors’ disciplinary records
- How I did it: Falsified charts in nursing homes linked to patient care
- Access Denied: Looking at a lack of health care availability
- Transparency & medical errors: Public reporting of patient harm is a potent force
