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)

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,

Hospital Beds and Care Team Staffing

Connection between High Hospital Occupancy and Death RatesA new study by the University of Michigan Health System study finds that admission to a hospital when most of the beds are already full can be deadly for patients: high occupancy increases the risk of dying in the hospital by 5.6 percent. Researchers compared a set of critical factors that can affect hospital deaths: hospital occupancy, nurse staffing levels, weekend admission and seasonal influenza. The study included 166,920 adult patients admitted to 39 Michigan hospitals over three years.

Having more nurses made patients safer, decreasing risk by 6 percent. But weekend admission raised the risk by 7.5 percent and admission during widespread seasonal flu had the greatest impact by increasing the risk of death by 11.7 percent, according to the study.

Source: University of Michigan Health System, March 9, 2010. http://www2.med.umich.edu/prmc/media/newsroom/details.cfm?ID=1512

John Goodman, Ken Thorpe, Uwe Rheinhardt

Editor’s note: a terrific piece by John Goodman with comments by some of the greatest minds in health care policy – debating some of the most salient points.

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Writing in Health Affairs, Ken Thorpe and his colleagues offer a description of the current phase of the problem:

Medicare beneficiaries’ medical needs, and where beneficiaries undergo treatment, have changed dramatically over the past two decades. Twenty years ago, most spending growth was linked to intensive inpatient (hospital) services, chiefly for heart disease. Recently, much of the growth has been attributable to chronic conditions such as diabetes, arthritis, hypertension, and kidney disease. These conditions are chiefly treated not in hospitals but in outpatient settings and by patients at home with prescription drugs.

So how are we dealing with this challenge? Poorly.

Now read more and the various rebuttals…at:

http://www.john-goodman-blog.com/the-mystery-of-health-care-policy/?utm_source=newsletter&utm_medium=email&utm_campaign=HA#more-9332

More Procedures = Higher Premiums and Higher Costs

Hospital Discharge Survey: Hip and Knee Joint Replacement Procedures

• From 1996 to 2006, the hospital discharge rate for total hip replacement increased by one-third, and the discharge rate for knee replacement increased by 70%.
• In 2006, total hip replacement rates were similar among men (18.1 discharges per 10,000 population) and women (20.5) . Discharges for partial hip procedures were about twice as common among women
  (23.9 per 10,000 for age 45 years and over) as men (13.0 per 10,000). Partial hip procedures, which are often used to treat fractures, were also more common among older persons.
• In 2006, knee replacement discharges were more common among women 45 years of age and over (54.0 per 10,000) than men (34.9). As with hip replacement procedures, knee replacement discharges were more than three times as high for those 65 years of age and over (84.1), compared with those 45–64 years of age (25.7).

Source: CDC/NCHS, National Hospital Discharge Survey.
Publication: Health, United States, 2009. http://www.cdc.gov/nchs/data/hus/hus09.pdf#specialfeature

Hospital ICUs could benefit from clinical dashboard implementation

Hospitals can improve patient safety and clinician workflow in their intensive care units by equipping the facilities with a clinical dashboard to enable medical providers to access patient data for use in charting and decision-making. Factors such as intensive collaboration and long-term experience with electronic medical records and computerized physician order entry systems could play a role in the successful automation of ICUs. Healthcare Informatics(3/2010)

Where are the Health Care Dollars Going

 

While the high cost of private health insurance has drawn plenty of attention in the health reform debate, an underlying driver of higher insurance premiums–the growing market power of hospitals and physicians to negotiate higher payment rates–has gone largely unexamined, according to a Center for Studying Health System Change (HSC) study published online Feb. 25 by Health Affairs.

Funded by the California HealthCare Foundation, the study examines the growing market power of many California hospitals and physicians, finding that providers are using various strategies, such as tighter alignment of hospitals and physician groups, to negotiate significantly higher payment rates from private insurers. The authors point out that California offers a cautionary tale for reform proposals that encourage hospitals and physicians to form tighter relationships through accountable care organizations.

“Health insurers have been squarely in the crosshairs and blamed for the high cost of private insurance, while the role of growing hospital and physician market power has escaped scrutiny,” said HSC Senior Consulting Researcher Robert A. Berenson of the Urban Institute, a coauthor of the study with HSC President Paul B. Ginsburg and Nicole Kemper, a former HSC research analyst.

http://content.healthaffairs.org/cgi/content/abstract/hlthaff.2009.0715

The Cost of In and Outpatient Surgeries

Nearly 58 percent of the surgeries performed in hospitals were done as outpatient procedures.  Outpatient surgery charges for hospitals totaled $55.6 billion, compared with $259 billion for inpatient surgeries.  [Source: Agency for Healthcare Research and Quality, HCUP, Statistical Brief #86: Hospital-Based Ambulatory Surgery, 2007.

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)