Dallas reporters use AHRQ data to measure patient safety
Filed under: Health data, Health journalism, Public health, Public records, Tools
The Dallas Morning News continues its 19-month investigation into patient safety at UT Southwestern Medical Center and Parkland Memorial Hospital.
The project, “First, Do No Harm: An investigation of patient safety in Dallas hospitals,” is behind the website’s paywall but The Dallas Morning News has granted AHCJ members access. To find out how to access the stories, please click here and log in as an AHCJ member.
Among the latest reporting:
Dallas Morning News reporters Ryan McNeill and Daniel Lathrop took advantage of AHRQ’s Patient Safety Indicator (PSI) software, typically used internally by hospitals, to process 9 million publicly available patient records from Texas hospitals, all of which came from between
Parkland, the prominent local hospital that has earned scrutiny on numerous prior occasions, was just the most notable of a number of area hospitals that came up short (and generated headlines), but our interest lies more with the reporters’ investigative methodology as well as the path they’ve blazed for broader hospital quality reporting.
All their work was done in consultation with experts in the field, including academics, government officials and hospital administrators. An outside review indicated McNeill and Lathrop used the software properly, and their results were in line with a similar public analysis. But that’s not to say it was a simple process.
The newspaper spent six months analyzing nearly 9 million state hospital discharge records using Patient Safety Indicators, or PSI, software. This highly sophisticated system was designed for the federal government as a tool to measure potentially preventable complications among hospital patients.
The PSIs do not present a complete safety picture because they are based on administrative data — a summary of diagnoses, procedures and outcomes derived from patients’ medical charts, as opposed to a complete review of all medical records.
It’s not a perfect measure, but it’s one of the best available.
PSIs “reflect quality of care inside hospitals,” according to the Agency for Healthcare Research and Quality, a division of the U.S. Department of Health and Human Services. It released the PSI software in 2003 and periodically updates it, most recently in August. The News used that version for its final analysis.
The software analyzes the administrative data that nearly every hospital in Texas reports to the state. No patient-identifying information is included.
The results on 15 PSIs are statistically “risk-adjusted” because some hospitals treat a disproportionate share of unhealthy patients, who face a greater risk of potentially preventable complications. Rates from eight of the indicators are used to determine a hospital’s patient safety “composite score.”
The AHRQ has just started posting some PSI measures on Hospital Compare, and the Texas health department plans to follow suit in 2013, but reporters looking to get their hands on a broader swath of the data will still have to follow the Dallas duo’s do-it-yourself approach.
The reporters’ work drew criticism from the Texas Hospital Association, which said the methodology was “not intended for use in public reporting.” McNeill refutes its claims in a blog post. Daniel K. Podolsky, president of UT Southwestern Medical Center, also sent a letter criticizing the reporting. George Rodrigue, managing editor of The Dallas Morning News, published a point-by-point response to Podolsky’s letter.
Dallas hospital CEO claims reporters have a vendetta
The chief executive officer of Dallas’ Parkland Hospital claims a “vendetta” held by the Dallas Morning News‘ investigative team is to blame for “chipping away” at the public’s trust in the hospital.
The newspaper used public records to extensively document billing fraud, poor supervision of residents, preferential treatment for VIPs and patient harm. The Centers for Medicare & Medicaid Services inspected the hospital in July and, less than two weeks ago, the hospital responded by posting its plan to correct deficiencies as required by CMS.
The Morning News reported that the hospital delivered the plan “just ahead of a deadline for addressing the problems or losing hundreds of millions of dollars in federal health care funding. If the agency, on reinspection, finds that the patient care deficiencies aren’t corrected, Parkland could lose nearly half its patient revenue.”
The hospital’s board decided yesterday to hire a consultant to “redefine [Dr. Ron] Anderson’s role with the system between now and the end of the year, when his five-year contract expires,” reports Bill Hethcock in the Dallas Business Journal.
Regardless, Anderson says the Morning News‘ coverage is “sincere, but sincerely wrong,” and raises the specter that people in the community will suffer because they won’t come to Parkland to seek care:
“They’ll suffer as much as anything that an investigative reporter thinks he’s doing or she’s doing for the benefit of the patients.”
In January, Maud Beelman, the DMN deputy managing editor who leads the investigative team, wrote about the project for Nieman Watchdog. She detailed some of the struggles they faced to do the project, including efforts to derail the investigation and the backlash from the hospital.
Inspired by NHS, Lieberman calls for reporters to spotlight patient safety improvements
Filed under: Europe, Government, Health data, Health journalism, Public health
Fresh off a trip to powwow with health journalists, academics and officials in England as a Fulbright Senior Specialist, AHCJ Immediate Past President Trudy Lieberman writes on CJR.org about what American health systems can learn from the British National Health Service when it comes to patient safety.
In particular, Lieberman looks at the NHS Institute for Innovation and Improvement, which has pushed a few simple changes that have lead to measurable and marked improvements in several key safety measures and are, she writes, embraced by “almost all U.K. hospitals.”
Since 2007 the Institute has fostered nurse-led innovations to improve care in such areas as patient hygiene, nursing procedures, meals, medicines, and ward rounds that frees up more time to be with patients. Now almost all UK hospitals embrace some of these practices. Positive stats from this “Releasing Time to Care” project show a thirteen percentage point increase in the median time spent on direct care; a seven percentage point increase in median patient satisfaction scores, and a twenty-three percentage point increase in median patient observations.
The innovations include little tricks like nurses donning red pinafores to signal “don’t interrupt me, I’m dispensing medication” and charting patient falls with red dots on a hospital floor plan, so that problem areas can be easily spotted.
According to Lieberman, simple changes like these don’t get the attention or widespread adoption they deserve. Thus, she ends her piece with a call to arms for health journalists, asking them to tell the stories of the sort of simple, easy-to-relate-to steps that are saving lives on both sides of the pond (Oregon, in particular, has been quick to follow the NHS lead in these areas).
So where does the press fit into all this? Media outlets in the UK and the US have something in common—they aren’t much interested in reporting good news and what works. It’s in our journalistic DNA to ferret out the evil, bad, and ugly with the hope that press exposure will change practice. But my visit to the NHS showed that positive change does happen and should be reported. Taylor told me she tried to interest British journos in some of the Institute’s achievements but got “not a sniff.”
“Journalists don’t celebrate success,” she said, “but innovation is to be shared.” Nor has there been any interest from U.S. reporters. CareOregon hasn’t sent out any press releases partly because the results are just coming in and because officials fear that the U.S. stereotype of the NHS is so powerful the program might die a-borning. If I were still a local consumer reporter, I would forget about all that ambiguous, hard-to-interpret data about hospital quality and look for concrete improvements patients and families can relate to, like red pinafores and scorecards for reducing falls. Then I would make a how-to comparison chart showing which hospitals were embracing some of the simple technologies that appear to work.
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.
Series reveals gaps in communication of hospital inspection results
Filed under: Government, Hospitals, Hot Health Headline
Jodie Jackson Jr. of the Columbia (Mo.) Daily Tribune took an in-depth look at patient safety at University Hospital, part of the University of Missouri Health Care system.
Jackson found that inspections, by CMS and the FDA, have repeatedly turned up systemic practices that compromised patient safety. At the same time, the Joint Commission awarded the hospital a full accreditation, raising questions about why the agencies don’t share information.
In a blog post, Jackson, a Midwest Health Journalism Program Fellow, says he has “examined some 700 pages of documents and have had national infection control leaders examine the reports that formed the basis for the series.”
- Patients in Peril?
- Hospital infections seen as ‘winnable battle’
- Inspection reports, hospital at odds
- Wash your hands
- ‘Superbug’ spurs patient’s activism
- Years after surgery, struggle continues
Las Vegas Sun’s Allen a finalist for Goldsmith Prize
AHCJ member Marshall Allen, with Alex Richards, is a finalist for the 2011 Goldsmith Prize for Investigative Reporting for their two-year investigation into preventable infections and injuries in Las Vegas hospitals.
Marshall Allen
The Las Vegas Sun reporters reviewed 2.9 million records for the reporting of “Do No Harm: Hospital Care in Las Vegas.”
Allen recently wrote an article for AHCJ members about making some of those inspection reports available for readers to see, using DocumentCloud. The technology allows readers to see the breadth of inspectors’ findings, including those that may not grab headlines but are just as important to the public.
Allen reports on health care for the Las Vegas Sun. As a member of the inaugural class of AHCJ Media Fellowships on Health Performance, he is exploring whether transparency about hospital quality improves the quality of care for patients. He has won Awards for Excellence in Health Care Journalism for his body of work in 2007, in the limited report and medium newspaper categories in 2008 and for his body of work in 2009. He was a member of the 2009 AHCJ-CDC Health Journalism Fellowship Program.
Initiatives not improving patient safety; poor implementation to blame
Filed under: Health data, Hot Health Headline, Studies
A large-scale study that followed mistakes in health care delivery at 10 North Carolina hospitals from 2002 to 2007 found that, despite state efforts, there was no improvement in patient safety over the time period. According to The New York Times‘ Denise Grady, the problem lay primarily not in design, but in execution. Even when safeguards were in place, they were not followed.
The study, published in the New England Journal of Medicine, reviewed thousands of patient records and looked for any of 54 red flags that something had gone wrong.
Dr. [Christopher] Landrigan’s team focused on North Carolina because its hospitals, compared with those in most states, have been more involved in programs to improve patient safety.
But instead of improvements, the researchers found a high rate of problems. About 18 percent of patients were harmed by medical care, some more than once, and 63.1 percent of the injuries were judged to be preventable. Most of the problems were temporary and treatable, but some were serious, and a few — 2.4 percent — caused or contributed to a patient’s death, the study found.
The findings were a disappointment but not a surprise, Dr. Landrigan said. Many of the problems were caused by the hospitals’ failure to use measures that had been proved to avert mistakes and to prevent infections from devices like urinary catheters, ventilators and lines inserted into veins and arteries.
Problems cited in the study include a lack of electronic medical records, doctors and nurses regularly working long hours and poor compliance with even simple interventions such as hand washing. Proposed solutions include computerized drug ordering systems and a mandatory nationwide monitoring system.
Report projects 134,000 hospital patients a month experience adverse events
More than 13 percent of hospitalized Medicare beneficiaries were harmed during a hospital stay, according to a study released by the HHS Office of the Inspector General (PDF, 81 pages).
The report is based on a review of a nationally representative sample of 780 patients in October 2008. Based on the sample, the report projects that 134,000 Medicare patients a month experience at least one adverse event during their hospitalization. About 1.5 percent died as a result of those adverse events, which projects to 15,000 patients in a single month.
From a financial standpoint, the report says the hospital care associated with those events cost Medicare an estimated $324 million in that month.
Adverse events, identified through a review of medical records, included the National Quality Forum Serious Reportable Events; Medicare hospital-acquired conditions; and events resulting in prolonged hospital stays, permanent harm, life-sustaining intervention, or death.
The reviewers found that 44 percent of the events were preventable, prompting the OIG’s office to recommend that the Agency for Healthcare Research and Quality and the Centers for Medicare and Medicaid Services “broaden patient safety efforts to include all types of adverse events and enhance efforts to identify events” and for CMS to “provide further incentives for hospitals to reduce adverse events through its payment and oversight functions, including strengthening the Medicare hospital-acquired conditions policy and holding hospitals accountable for adopting evidence-based practices.”
Related
Quest for profit behind patient safety problems in Las Vegas hospitals
Marshall Allen, of the Las Vegas Sun, continues his look at patient safety in Las Vegas hospitals and has been able to boil down the problems to several themes that explain the 3,689 preventable infections, injuries and surgical accidents that happened to Las Vegas hospital patients in 2008-09.
Allen notes that Nevada and the Las Vegas area have more for-profit hospitals than any other state or urban county in the nation. He found that “the corporate push for profits sometimes trumps patient care and can create an environment where best practices give way to risky shortcuts.” Additionally, Las Vegas does not have any academic medical centers, which normally “elevate a city’s health care because of their focus on excellence, innovation and research.” Other problems include staffing, poor oversight and hospitals that cover up harmful incidents.
In this installment, part four of the paper’s “Do No Harm” series, Allen tells of patients who suffered serious wounds, infections and injuries, as well as the story of one man who died after receiving painkillers.
Beyond the data, documents and anecdotes about patients who suffered harm in Las Vegas hospitals, there is evidence from the nurses who work in those hospitals that points to the problem. The Sun published information from a 2005 study about why new nurses quit their jobs in Nevada. The study, published in the Journal of Nursing Administration, found that patient safety issues were the most frequent reasons for leaving among 325 newly hired nurses.
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.
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New at HealthJournalism.org
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