To Err is Human — Some Tools to Help

Hospitals are changing culture of handling medical errors
Assessing blame for medical errors is difficult, and hospitals are looking to see if their own systems may be partly responsible when providers make mistakes. The National Quality Forum has developed a Care of the Caregiver standard, and the Just Culture model stresses the middle ground between blaming a physician or nurse and holding a system failure accountable. The Wall Street Journal (3/16)

Comparative Effectiveness – The First Act

FDA Eyes Setting Up Two CER Centers To Leverage Agency Data
Even though FDA does not have explicit statutory authority to mandate that new products are superior to legacy medical interventions, the new centers would provide the agency with strategies to potentially incorporate CER into its new life-cycle approach to regulating health care products. [ Inside Health Reform | Mar 11,

Too Many Tests – Impact Your Health

Top Stories   Study Suggests Too Many Invasive Heart Tests Given A troublingly high number of U.S. patients who are given angiograms to check for heart disease turn out not to have a significant problem, according to the latest study to suggest Americans get an excess of medical tests. [ Associated Press | Mar 10,

From Fee for Service to Fee for Care

Support grows for move to bundled payments
Many health policy experts say it is time to dump fee-for-service physician reimbursement and move to a bundled payment model that could save money without reducing quality of care. Pilot programs have shown that the model can offer high-quality care, greater patient satisfaction and lower costs. The Washington Post (3/9)

Group appointments are a growing trend
Health care providers say patients like group appointments because they cut down on wait times, give them more face time with physicians and allow them to share experiences with other patients. The Future of Family Medicine Project named group visits one of 10 trends to be taken seriously. The Washington Post (3/9)

What Requires Legal Change and What Doesn’t?

Editor’s note: What requires new laws? What requires regulatory intervention? And what will not yield regardless?

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Estimated range of healthcare system waste is $600-$850 billion annually

At President Obama’s Healthcare Summit, SEN. Tom Coburn cited Thomson Reuters’ white paper “Where Can $700 Billion In Waste Be Cut Annually From the U.S. Healthcare System?” The report identifies the most significant drivers of wasteful healthcare spending as follows:

1. Administrative System Inefficiencies: $100-$150 billion

2. Provider Inefficiency and Errors: $75-$100 billion

3. Lack of Care Coordination: $25-$50 billion

4. Unwarranted Use: $250-$325 billion

5. Preventable Conditions and Avoidable Care: $25-$50 billion

6. Fraud and Abuse: $125-$175 billion

Source: Thomson Reuters. “Where Can $700 Billion in Waste Be Cut Annually From the U.S. Healthcare System?” October 2009. http://www.factsforhealthcare.com/whitepaper/HealthcareWaste.pdf

Foundational Literature For Quality Measurement

National Quality Forum: Measuring Efficiency Across Episodes of Care

This new report presents the National Quality Forum-endorsed measurement framework for assessing efficiency, and ultimately value, over the course of an episode of care.

Study: 26% of referrals for imaging scans were inappropriate

A study of the medical records of 459 patients referred by their primary care physicians for diagnostic CT, MRI or PET scans found that 26% of the referrals weren’t appropriate because they didn’t follow guidelines that closely resemble those created by the American College of Radiology. The study results “suggest a need for tools to help primary-care physicians improve the quality of their imaging decision requests,” the lead author of the study said. Modern Healthcare (free registration) (3/2)

Overuse and Misuse

More PCT testing could reduce unnecessary antibiotic use
If physicians commonly tested patients for procalcitonin, or PCT, it would help them identify those whose respiratory tract infections respond to antibiotics and help prevent prescribing unnecessary drugs, researchers said. The study estimated antibiotic prescriptions for respiratory tract infections could drop by more than 40% if the simple test was used routinely. MSNBC/Reuters (2/25)

Health Grades: America’s Best Hospitals

HealthGrades releases top hospital list
HealthGrades’ fourth annual report of the 50 best hospitals in America showed those making the list had mortality rates 27% lower than other facilities, on average. The top hospitals are located in 17 states, with Florida and Ohio having the most, with nine each. Modern Healthcare (free registration) (2/24)

Following Guidelines Improves Overall Outcomes

Editor’s note: Are these finding extendable to a myriad of other conditions? Experience would indicate that it is. See http://www.leapfroggroup.org for additional information.

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Patients fare better when hospitals use stroke protocol
Stroke patients taken to hospitals that follow specific treatment protocols had a 10% better chance at survival, study data found. Researchers analyzed 1 million patients treated at hospitals in the “Get With The Guidelines” program that includes seven specific steps for treating stroke patients. HealthDay News (2/22)