Mass. won’t post hospitals’ death rates
Filed under: Health data, Hot Health Headline, Public records
The Boston Globe’s Liz Kowalczyk reports that, two years after it was first proposed by a consumer group, the Massachusetts Health Care Quality and Cost Council has decided it won’t publish hospital-wide mortality rates. The problem, it seems, is the lack of an accurate, universal method of computing such numbers.
Health and Human Services Secretary Dr. JudyAnn Bigby, who heads the group that made the decision, said current methodology for calculating hospital-wide mortality rates is so flawed that officials do not believe it would be useful to hospitals and patients and could harm public trust in government.
It appears, Kowalczyk writes, that general hospital mortality rates just aren’t “ready for prime time” quite yet.
The council convened an expert panel, which worked with researchers to evaluate software of four companies for measuring hospital mortality. The problem was that researchers came out with vastly different results when they used the various methodologies to calculate hospital mortality between 2004 and 2007 in Massachusetts, and they could not tell which company’s results — or if any — were accurate.
Analysis of billing record data reveals hospital quality issues in Las Vegas
Using data from hospital billing records, Marshall Allen and Alex Richards of the Las Vegas Sun have been able to identify “hospital-acquired patient harm,” that is, events in which patients are harmed while in the hospital.
Medicare does not pay for these “never events” and so they are reflected in hospital billing codes. Such events include things like leaving foreign objects in a patient, bed sores, falls, infections related to catheters or surgical sites, blood clots and poor glycemic control.
Nevada – and 40 other states – collect such data for analysis, Allen and Richards report. In Nevada, the state had not yet analyzed the data so the reporters requested it and did the analysis.
The pair requested and received records for “every Nevada hospital inpatient visit going back a decade — 2.9 million in all. The information, coupled with interviews with more than 150 patients and health care insiders, has yielded a sweeping and detailed portrait of hospital care in Las Vegas.”
The project includes stories about patients who were harmed while hospitalized, the documents behind the reporting, data tables, interactive graphics and more.
Patient safety expert Pronovost is keynote speaker
Peter Pronovost, M.D., Ph.D., a professor at Johns Hopkins University and founder of the Quality and Safety Research Group, will be the keynote speaker at Health Journalism 2010. He will appear at the awards luncheon on Saturday, April 24.
Peter Pronovost, M.D., Ph.D.
Pronovost specializes in improving patient safety through methods that are scientifically rigorous but feasible at the bedside. In his new book, “Safe Patients, Smart Hospitals: How One Doctor’s Checklist Can Help Us Change Health Care from the Inside Out,” Pronovost tells of losing his father as the result of a medical error and his own journey from a researcher to an international leader in patient safety.
Pronovost joins a number of high-profile speakers. Conference participants will have the chance to attend newsmaker briefings featuring leaders from the Department of Health and Human Services, the Centers for Disease Control, the Food and Drug Administration:
- Thomas Frieden, M.D., M.P.H., director, Centers for Disease Control and Prevention
- Kathleen Sebelius, M.P.A., secretary, U.S. Department of Health and Human Services
- Jeffrey Shuren, director, Center for Devices and Radiological Health, Food and Drug Administration
A special track on assessing health reform is intended to help reporters understand the changes coming and better explain what’s ahead to their readers, viewers and listeners:
- Does comparative effectiveness research work?
- Outlook for the nation’s hospitals
- Is there a looming doctor shortage?
- What’s ahead for state and local governments
- The reporting challenge going forward
“Influenza! Lessons learned from a year of H1N1″ will feature experts on public health, infectious diseases, preparedness and vaccines:
- Jeffrey Levi, Ph.D., executive director, Trust for America’s Health
- Anne Schuchat, M.D., director, CDC’s National Center for Immunization and Respiratory Diseases
- Litjen Tan, Ph.D., director of medicine and public health, American Medical Association; co-chair, National Influenza Vaccine Summit
- Moderator: Maryn McKenna, independent journalist, Minneapolis
See the complete conference schedule.
Reports reveal problems in England’s NHS
England’s Care Quality Commission, a regulatory agency, has found that a quarter of the National Health Services hospital trusts fail to meet basic standards of hygiene, according to The Telegraph’s Andrew Hough.
Some of the failures included 36 trusts not providing areas to decontaminate instruments, three trusts failing to regularly flush unused water outlets while more than a dozen trusts failed to keep clinical areas clean.
As Hough reports, the revelations come just days after a BBC investigation found that hospital trusts have given incorrect information on their performance and quality of care.
Related
Conflicting demands on their job and being rushed or understaffed were common problems revealed by a recent survey of employees of England’s National Health System, as The Telegraph’s Rebecca Smith reports.
The NHS, according to its Web site is “the world’s largest publicly funded health service” with more than 1.7 million employees. The survey was done by the Care Quality Commission.
The CQC reports some improvements in job satisfaction, however:
Approximately half of all staff would recommend their trust as a place to work, and just under two thirds are happy with the standard of care provided by their trust. There has also been a substantial rise in the % of staff saying that they have had training in infection control.
Joint Commission finds improved hospital quality
Filed under: Conflicts of interest, Health data, Hospitals, Pharmaceuticals, Studies
The latest report from The Joint Commission, a hospital accrediting organization, finds that “overall, hospitals are following evidence-based standards for treatment of myocardial infarction, heart failure, and pneumonia,” as MedPage Today reports.
The report, which looks at 31 evidence-based measures, did find decreases in two areas: measuring oxygen in blood for pneumonia patients and administering antibiotics to pneumonia patients in the intensive care unit within 24 hours.
The report, “Improving America’s Hospitals: The Joint Commission’s Annual Report on Quality and Safety 2009,” (PDF) and those from three previous years are available on the commission’s Web site. Among the key findings:
- Hospitals accredited by The Joint Commission have significantly improved the quality of care provided to heart attack, heart failure and pneumonia patients over a seven-year period.
- Hospitals have steadily improved on individual surgical care performance measures – as well as on additional individual heart attack and pneumonia care measures - over a two-, three- or four-year period.
- Hospital performance on two individual measures of quality relating to inpatient care for childhood asthma is excellent after only one year of measurement.
- Improvement is still needed.
- Where a patient receives care makes a difference.
As ProPublica’s Charles Ornstein explains in his tip sheet, The Joint Commission does routine inspections of participating hospitals to ensure they meet the standards required for accreditation. It compiles public reports on each hospital, which are available on the qualitycheck.org Web site. These reports include the hospital’s accreditation status, as well as some data on hospital outcomes and practices.
It does not release its detailed inspection reports to the public, and many states’ open records laws specifically exempt the reports from public disclosure. In the past, these inspections have not been surprises, and the group has been faulted for being slow to act against hospitals with problems Also, The Joint Commission rarely takes punitive steps against hospitals, preferring to work with them to improve.
Tip Sheets
A road map for covering your local hospital’s quality
Study: Hospital quality comparisons are inconsistent
News: Congress requires Joint Commission to re-apply for accreditation privileges (Sept. 17, 2008)
Obama initiatives include VA hospital report cards
Filed under: Government, Health journalism, Hospitals, Public records
Saying that “commitment to open government goes beyond the making of government-wide policy for the future,” the White House announced a number of “open government” initiatives on Tuesday.
The initiatives come with an “Open Government Directive” (PDF) from Peter Orszag, director of the White House’s Office of Management and Budget, that sets out steps toward creating a more open government and establishes deadlines for action:
- Publish Government Information Online - Includes a requirement that each agency create an Open Government Web page within 60 days.
- Improve the Quality of Government Information - Within 45 days each agency must designate an official to be accountable for the quality and objectivity of federal spending information
- Create and Institutionalize a Culture of Open Government - Within 120 days, each agency will publish on its Open Government Web page an a plan about how it will improve transparency and public participation.
- Create an Enabling Policy Framework for Open Government - Officials will review OMB policies to find impediments to open government and propose changes to increase openness.
Photo by Ed Dame via Flickr
The specific initiatives just announced come from all departments of the cabinet. One of the most notable is a hospital report card that will include raw data for veterans administration hospitals:
To empower Veterans and the public at large to track quality, safety, and access to Veterans Health Administration (VHA) facilities, the Department of Veterans Affairs is publishing hospital “report cards,” including raw data on care provided in outpatient and hospital settings, quality of care within given patient populations, and patient satisfaction and outcomes.
Other health-related initiatives include:
Department of Health and Human Services, Department of Agriculture, Department of Commerce, Department of Energy & the National Aeronautics and Space Administration: National Assets for High-Tech Economic Growth
Fledgling businesses need easier ways to identify and assess entrepreneurial opportunities that will create jobs and strengthen economic growth. Towards that goal, the National Institutes of Health (NIH) and Food and Drug Administration (FDA) in the Department of Health and Human Services (HHS), the Agricultural Research Service in the U.S. Department of Agriculture, the National Institute of Standards and Technology (NIST) in the Department of Commerce, the Department of Energy, and the National Aeronautics and Space Administration are increasing access to information on 1) new technologies available for commercial licensing, 2) Cooperative Research and Development (CRADA) awards and opportunities, 3) Small Business Innovation Research (SBIR) awards and opportunities, 4) Small Business Technology Transfer (STTR) awards and opportunities, and 5) projects sponsored through grants and contracts.
Department of Veterans Affairs: Geographic Distribution of Expenditures
The National Center for Veterans Analysis and Statistics will release three years of raw data on estimated annual VA spending in each county and congressional district. The data represent payments to Veterans and dependents, services provided to Veterans, and general operating expenses. These data will be used by state and local Veteran agencies, Veteran advocacy groups, and the public to compare to and plan for local Veteran needs. Making the raw data available will enable its combination with local-population and veteran-related data, fostering new knowledge and improved services for Veterans.
Department of Agriculture: Promoting a Healthier America
To unleash innovative approaches to improving the health of America’s children, the Department of Agriculture is releasing nutrition data for over 1,000 commonly consumed foods and launching a national competition for creative, mobile and web-based games. The competition will challenge entrepreneurs, software developers, and students to leverage the newly released data to develop games to help children make healthy eating decisions.
Department of Labor: Keeping America’s Workers Out of Harm’s Way
For the first time, the Occupational Safety and Health Administration in the Department of Labor is systematically publishing employer-specific information about occupational fatalities online. Employers with reported fatalities will have an incentive to take steps to improve safety and prevent future accidents. In addition, responsible employers will be able to use the database to identify dangerous conditions and take proactive precautions.
Department of Veterans Affairs: Veteran Population Model
The Veteran Population Model - using combined data from the Department of Veterans Affairs (VA), Department of Defense (DoD), and Bureau of the Census - provides the official estimates and projections of the veteran population for each year from April 1, 2000, through September 30, 2036. Previously available only through predefined queries, access to the raw data will enable public and private-sector service organizations to incorporate VetPop data into their models to project future demand based on population and demographic estimates.
Q&A on achieving a more open government
Chief Technology Officer Aneesh Chopra and Chief Information Officer Vivek Kundra take questions on the directive and the move to a more transparent government.
Nursing blog marks anniversary of landmark report
In a two-week series of posts, the INQRI blog – the blog of the Interdisciplinary Nursing Quality Research Initiative – is recognizing the 10th anniversary of “To Err is Human,” the groundbreaking report that found that as many as 98,000 people die each year from medical errors in hospitals.
A nurse vaccinates a child in this CDC photo.
The latest post, written by Barbara Olson of Florence dot com, looks at the building blocks of better health care. She says that ten years of studying how to make health care reliable has revealed that “things like speaking clearly, repeating words to be certain they have been understood; taking turns; using “inside” voices; and getting plenty of rest matter when individuals rely on complex processes to deliver intended outcomes. (Even “time-outs” have made a comeback!)”
Earlier posts include a Q&A with Paul Levy, president and CEO of Beth Israel Deaconess Medical Center in Boston; one that warns that we may not have made much progress in the area of patient safety; and a post about a nurse researcher who has found that a positive work environment helps nurses catch errors before they harm patients.
AHRQ interviews Ornstein, talks medical errors
Filed under: Health data, Health journalism, Hospitals, Public records
Robert Wachter, M.D., (bio), editor of AHRQ WebM&M (Morbidity and Mortality), interviewed AHCJ President Charles Ornstein, of ProPublica, for a recent issue (get the audio version here). Their conversation began as a general discussion of health journalism, then zeroed in on hospital errors and the Pulitzer Prize-winning series on King/Drew Medical Center in Los Angeles that Ornstein did with Tracy Weber when both were at the LA Times.
The whole thing is worth a read. In this excerpt Ornstein discusses how health journalists find stories:
Good reporters have a variety of sources of information. Reporters who routinely cover the hospitals in their communities should be constantly looking at state inspection reports, lawsuit data about payouts, their Joint Commission accreditation, and how they’re doing with their training program. All these types of things should be on the radar screen and monitored regularly. But nothing can replace talking to employees in the facilities and the patients that receive care there—trying to get an on-the-ground perspective.
In a companion piece, Wachter reflected on the role the media has played in shaking the medical profession out of a dangerous rut of complacency:
What do we need from reporters who cover the medical errors beat? … reporters need to know enough about error science that they appreciate the importance of searching for systems factors, without immediately zeroing in on more dramatic and obvious sharp-end errors. They need to get the facts right. And, while raising the appropriate concerns, they need to avoid sensationalism and place the error, or the topic, in broader context. When they do these things, they are providing a unique and critical service to patients and caregivers.
11 Calif. hospitals fined for preventable mistakes
Cheryl Clark writes for HealthLeaders Media that 11 California Hospitals were fined $25,000 each by the state for mistakes that put patients in immediate jeopardy or, in a few cases, even injured or killed them. Among the most egregious mistakes were a “man undergoing a leg amputation for cancer he never had,” a patient being set on fire during an eyelid-related procedure and a laundry list of equipment forgotten inside of patients.
This naming and shaming of errant hospitals has become a regular ritual in California, Clark reports:
Kathleen Billingsley, deputy director for the California Department of Public Health, said the 11 new fines bring the total of 115 monetary penalties against 80 hospitals to $2.87 million under a law that took effect Jan. 1, 2007. She has made public announcements about other batches of fines seven times previously, most recently Sept. 3.
According to the Web site’s “About Us” page, “HealthLeaders Media is a leading multi-platform media company dedicated to meeting the business information needs of healthcare executives and professionals.”
USA Today matches hospital quality data, tourism
Filed under: Health data, Health journalism, Hot Health Headline
USA Today’s Steve Sternberg and Jack Gillum put a new spin on federal Hospital Compare ratings and other hospital quality data, matching the ratings, as well as data on death rates, with popular travel destinations and the locations of state parks. The reporters make the case that travelers should keep hospital quality data in mind when planning vacations.
From the story, which also includes a list of poorly-rated hospitals in travel hotspots:
A USA Today analysis finds two dozen hospitals near popular travel destinations, as compiled by the National Travel Monitor, have death rates among the worst in the USA. A separate analysis shows that one of every four hospitals with high death rates for heart attack, heart failure or pneumonia — 94 of 402 — are near state parks.
Related
AHCJ Vice President Charles Ornstein, whose own hospital quality coverage has earned national recognition, recently updated his comprehensive “Road map for covering your local hospital’s quality” tip sheet with links to state-by-state resources and additional nationwide tools for journalists looking into hospital quality.
AHCJ article: Making sense of hospital quality reports
Book: Covering the Quality of Health Care: A Resource Guide for Journalists
Slim guide: Covering Hospitals: Using Tools on the Web
Free online training
On the Beat: Covering Hospitals: An innovative simulation guides you through the sources and resources you need to tackle the beat. You’ll tap into the same tools that you’ll use on the job, and you’ll have a virtual mentor to walk you through the maze of reports, statistics and sources. One story line teaches you about reporting on hospital quality
Data
Investigating hospitals: Find stories with ready-to-use Hospital Compare data: AHCJ has made it easier for journalists to compare hospitals in their regions by generating spreadsheet files from the HHS database, allowing members to compare more than a few hospitals at a time, using spreadsheet or database software. AHCJ provides key documentation and explanatory material to help you understand the data possibilities and limits.
Tip sheets
- How to cover your local hospital - Overview of many organizations that offer hospital quality ratings
- Sorting out hospital rankings
- Intro to investigating health data using spreadsheets
- Computer-assisted reporting basics: Investigating health data using spreadsheets
Reports
- Study: Hospital quality comparisons are inconsistent
- Performance data may not affect patient decisions
- GAO report on reliability of hospital quality data reported to CMS
- 2007 state quality data available
- Hospital quality resources by state
Hot Health Headlines
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Spend a week at the CDC studying public health, meeting sources. Apply for the AHCJ-CDC Health Journalism Fellowships today!
- Reporting on the intersection of health, environment
- Tip sheet: Covering cuts to Medicare reimbursements
- Briefing: Reporting on health reform between now and 2014
- Covering high-risk insurance pools: Tips for reporters
- Health care reform has passed: What's next?
- Health and education: Covering these intersecting beats
- Reporting on the business of health care
- Health reporting resources for journalists on state and local government beats
