1) Access the Hospital Compare website (https://www.medicare.gov/hospitalcompare/search.html) and select a local hospital. Look at the hospital’s publically reported indicators for Process of Care.
2) Write a paper of 1,000-1,200 words that analyzes how the selected hospital performs on these indicators versus two of its competitors. Include your thoughts on the pros and cons of publically reporting these data sets.
3) Refer to the website and incorporate specific examples and details into your paper.
4) Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
5) This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment.
You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.
HCA 675 Lecture
The New Focus on Quality and Outcomes
In 1999, the Institute of Medicine (IOM) published a groundbreaking analysis of the impact of medical errors on the health care delivery system and the patients it serves. The analysis, published as “To Err is Human: Building a Safer Healthcare System,” concluded that medical errors resulted in up to 98,000 patient deaths in American hospitals every year. This report hit the national press and participants in the health care system and the political system with the force of a large bomb. Since that time, hospitals and other health care entities have refocused their attention on quality, errors, and patient safety in an unprecedented way, urged on by public outcry and by federal and state efforts to compel improvements in the health care system. Such entities as the Institute for Healthcare Improvement (www.ihi.org) the National Quality Forum (www.qualityforum.org), and the Institute of Medicine (www.iom.edu) have all emerged as champions of quality and safety initiatives, offering training, resources, access to best practices, and data collection strategies to move the cause of quality and safety for patients forward.
The IOM report had a huge impact on the discussion of quality and safety in the health care field. Aspects of quality care have always been present in hospitals, typically focused around the quality assurance or quality management departments. They historically collected data on department indicators and monitored them as part of accreditation. However, departmental data was typically focused on operational performance in the departments in question, and not a great deal was collected on issues of medical errors and near-misses. The litigious legal climate caused most hospitals to fear collecting and sharing data that could potentially be used against them in a legal action. However, the IOM report caused a national demand to know what health care institutions were doing to protect their patients from injury caused by errors. A climate of increased transparency has begun to emerge, although it is still a very long way from the concept of full openness on standardized reporting of indicators. The Centers for Medicare and Medicaid Services (CMS) weighed in with publication of their never-events, as explored further below.
Finally there has been an increased push for public reporting of data on individual hospital performance on selected indicators. While some progress has been made, there is a large range of indicators that is not yet publically reported, and medical errors are not publically reported at all at this point, although those with great potential to cause harm must be reported to their relevant state licensing agency.
What Is Happening Now
Out of all this push has come an increasing focus on patient safety as a critical aspect of health care quality. Hospitals and other health care institutions are experimenting with the creation of cultures of quality, wherein mistakes are not seen as inevitable byproducts of human performance but as preventable events in systems hardwired not to allow them. Others are implementing a “just culture,” whereby it is safe to report errors and near-misses as a technique of analysis and prevention rather than as a punitive, punishment-oriented approach. In many facilities, staff who make an error are encouraged to share that with other staff members, teaching and coaching on how to avoid making the same mistake. Quality departments are performing root cause analyses to identify system failures and opportunities to improve safety.
Hospitals are also responding to multiple requirements by many constituencies for reporting data. This highlights a problem with the current health care system that drives up cost for questionable benefit. Different regulatory agencies are requiring the report of different indicators, forcing hospitals to access their information systems for various different reports. The lack of a standardized list of indicators for safety and quality performance causes an increased workload on the part of health care providers, who must scramble to achieve the reporting requirements and commit expensive resources to access databases that may not be user-friendly to produce the needed reports. The lack of a national standard for quality indicators is causing extra work in the system that could be focused elsewhere if everyone was collecting the same data sets. CMS is attempting to standardize its indicators and adding to them on an ongoing basis, which could serve as the basis for a national standard of validated outcomes and measures.
Two examples of this are the never-events and the perfect care standards.
·The never-events are 11 indicators for which CMS has said it will not reimburse hospitals if the events occur during the hospital stay. These events have been shown to be preventable if care is rendered in certain, best-practice ways. They include the following:
oAdministration of incompatible blood products
oCatheter-associated urinary tract infections
oPoor control of blood sugar levels
oDeep vein thrombosis or pulmonary embolus after surgery to replace a hip or knee joint
oIn-hospital patient falls with resultant trauma
oRetained foreign bodies in the surgical site after surgery
oSurgical site infections after certain orthopedic and bariatric surgeries
oSurgical site infections after open heart surgery
oVascular catheter-associated infections
·The perfect care standards include outcomes and activities for hospitals to follow for patients with acute myocardial infarction, congestive heart failure, pneumonia, surgical care improvements, and others. These data are publically reported by CMS for the bulk of U.S. hospitals on the Hospital Compare Web site (www.hospitalcompare.hhs.gov). The data can be accessed by anyone who may be interested in hospital performance.
What Is Still Needed
While efforts at measuring and reporting quality are significant early steps, there are still aspects of the push for improvements in quality that need to be addressed.
Data Transparency: Historically hospitals and other health entities have been reluctant to expose their mistakes to outside scrutiny, for fear of sparking legal action against them. However, the need to be transparent in publishing quality indicators and evidence of errors is becoming more and more important. The public is slowly becoming aware that operational and quality data are available to them, and there is increasing interest in seeing how hospitals perform. In addition, hospitals are becoming more open to reporting their errors and near-misses, along with root-cause analyses that demonstrate how to keep the error from reoccurring. CMS has been a leader in compelling the release of information on how hospitals perform on specific indicators, by tying the availability of such information to payment for Medicare patients.
The Internet: A key element driving increased public awareness of errors and quality indicators in health care has been the easy availability of information on the Internet. With a few mouse clicks, access to public comparison of hospital performance data across hospitals is easy. Individuals considering surgery or other procedures can identify several hospitals in their zip code and compare those hospitals on key indicators. While this is still very much an early emergence, it will become much more common in the future. In the past, patients relied on their physicians to tell them what hospital to use and that is still a common practice today. However, the patients who bring reams of printed information on a given disease to their physicians to test the current state of their knowledge will also do extensive research on the hospital that would provide their care. Increasingly, physicians may advise the use of a specific hospital, but the prospective patient will do his or her own research on the publically reported performance of that hospital prior to making the final choice. For instance, the Hospital Compare Web site lists data for reporting hospitals on processes of care, outcomes of care, the use of imaging services and radiation exposure, the patients’ experiences at the hospital, and the hospital’s Medicare payments and volume for selected procedures.
A Validated, Standardized National Reporting System: As previously noted, hospitals and health care entities are being subjected to a barrage of requests for data from a wide variety of sources, including government, state regulatory agencies, and insurance companies, among others. All are focusing on different data indicators, measured in different ways, to suit their individual data needs. The entire health care system would greatly benefit from a national standardized data set that all entities, including providers and payors, agree to utilize as a means of reporting and measuring the quality of their services and outcomes. At this point, no real effort is being made to create such a national data set, but as hospitals continue to struggle with reporting multiple data sets to multiple outside entities, national organizations such as the American Hospital Association may be prompted to step in and attempt to negotiate such an agreement. Alternatively, CMS could provide leadership on what data sets are acceptable nationally, particularly as it may begin to cover more Americans for their health care.
Standardized Clinical Practices Based on Evidence: A number of national studies have historically reported wide variation in practice and outcomes for health services across the country. For more than 20 years, the Dartmouth Atlas of Health Care (www.dartmouthatlas.org) has studied how medical resources are distributed and used in different areas across the United States and has noted glaring variations. Of interest, the best outcomes frequently do not correlate with the amount of money spent on health care services. Data can be examined by region, hospital, or topic of care. Hospitals and practitioners all exhibit wide variations in the types and quality of care they render across geographic areas. The Agency for Healthcare Research and Quality (http://www.ahrq.gov) has received $300 million to fund comparative effectiveness research. In this type of study, different patterns of care are compared to determine how effective they are and how they compare to other patterns for care for the same disease. The results can provide a basis for determining the health care services and interventions that work to produce desired outcomes versus those that simply do not work as anticipated or that do not work as well. The financial implications of this research could be tremendous, as payors use evidence to determine what services they will reimburse and what services are not effective.
The Electronic Medical Record (EMR): The Holy Grail of health care informatics is the pursuit of the ideal EMR. There seems to be consensus that the electronic collection of data and information on health care provided and patient outcomes, which move across the continuum of care, could serve as a jumping off point for measuring and adapting care to evidence-based standards. It should also make public data reporting a simpler process than it currently is. Ideas have been put forward that include a patient’s ability to carry his or her entire medical history and information on a credit card-sized device. Such a device could be screened by any provider to determine the patient’s essential medical information, without recourse to paper records. The dilemma is that multiple EMR systems have been developed by multiple vendors for hospital and provider use. However, while they are all Health Level Seven International interface-compliant, they do not exchange data easily or at all. So a patient who has his or her information coded by system X may find it useless if he or she goes to a provider that uses system Y. EMRs also cost millions of dollars to purchase, install, train, and implement, and many health care entities are suffering from capital resource starvation. The federal government has set up financial incentives to support and subsidize a portion of the purchase and has instituted financial penalties for entities that do not have significant portions of an EMR in place by 2015. However, both the financial and personnel resources required to design and implement an EMR are a huge challenge for health care entities at this point. Any choice that is made can have very expensive negative outcomes if not done properly, and the risk to hospitals and providers is significant.
There has never been more health care quality innovation occurring in the delivery system than at the present time, and it has never been more difficult or complex to determine what will be successful and what will be an expensive mistake. The stakes are great for many health providers and in some cases will determine organizational survival. The management of quality outcomes, the need to standardize care delivery, the importance of controlling high cost utilization, and the demand for better outcomes all combine to make it a very risky time for health care providers. However, the demand for all of these is unrelenting by a public that insists that Americans have the best health care system in the world.
HCA-675 | The New Focus on Quality and Outcomes-Library Resource
1. Determining Minimal Risk for Comparative Effectiveness Research
Read “Determining Minimal Risk for Comparative Effectiveness Research,” by Joffe and Wertheimer, from IRB: Ethics and Human Research (2014).
2. The Role of Patient Spirituality in a Culture of Safety
Read “The Role of Patient Spirituality in a Culture of Safety,” by Cascio, from ONS Connect (2016).
3. Tooling Up to Prevent Never Events
Read “Tooling Up to Prevent Never Events,” by Cantrell, from Healthcare Purchasing News (2016).