A new study from the University of Pennsylvania School of Nursing affirms a straightforward premise: Nurses are accurate barometers of hospital quality.
Perceptions from nurses — the healthcare providers most familiar with the patient experience — about hospital quality of care closely matches the quality indicated by patient outcomes and other long-standing measurements.
“For a complete picture of hospital performance, data from nurses is essential,” said lead author Matthew D. McHugh, a public health policy expert at Penn Nursing. “Their assessments of quality are built on more than an isolated encounter or single process — they are developed over time through a series of interactions and direct observations of care.”
Nurse-reported quality accurately correlated with outcome measures including death and life-threatening post-surgical complications, and patients’ reports of the care experience, wrote Dr. McHugh…
- Overworked nurses report medical errors (cbc.ca)
- Hospital wards ‘neglected’ to due lack of staff and money (standard.co.uk)
- Patients being treated ‘like medical conditions, not people’ – Telegraph (telegraph.co.uk)
Durably improving health is really, really hard.
I’ve discussed this in the context of drug discovery, which must contend with the ever-more-apparent reality that biology is incredibly complex, and science remarkably fragile. I’ve discussed this in the context of patient behavior, focusing on the need to address what Sarah Cairns-Smith and I have termed the “behavior gap.”
Here, I’d like to focus on a third challenge: measuring and improving the quality of patient care.
I’ve previously highlighted the challenges faced by Peter Pronovost of Johns Hopkins in getting physicians to adhere to basic checklists, or to regularly do something as simple and as useful as washing hands, topics that have been discussed extensively and in a compelling fashion by Atul Gawande and others….
…Consider the recent JAMA article (abstract only) by Lindenauer et al. analyzing why the mortality rate of pneumonia seems to have dropped so dramatically from 2003-2009. Originally, this had been attributed to a combination of quality initiatives (including a focus on processes of care) and clinical advances. The new research, however, suggests a much more prosaic explanation: a change in the way hospitals assign diagnostic codes to patients; thus, while rates for hospitalization due to a primary diagnosis of pneumonia decreased by 27%, the rates for hospitalization for sepsis with a secondary diagnosis of pneumonia increased by 178%, as Sarrazin and Rosenthal highlight in an accompanying editorial (public access not available).
Why did the coding pattern change? Multiple explanations were proposed by the authors; possibilities range from the benign — changes in diagnostic guidelines, greater awareness of sepsis, etc. – to the cynical (and quite likely) — utilizing different coding to maximize reimbursement.
One key take-home is that reliable measurement of health variables is so much more of a challenge than is typically appreciated, and ensuring that we’re robustly measuring what we think we’re measuring, rather than a paraphenomenon, is going to be very important. We’re learning this lesson the hard way in so many areas of science, and health outcomes research is unlikely to be the solitary exception.
A second and equally important lesson is to remember that in many cases in health outcome research, the people who are doing the measurements and assessments often have a significant stake in the results, introducing the very real possibility of data distortion….
Patients, providers and the public have much to celebrate. This week, the Centers for Medicare and Medicaid Services’ Hospital Compare websiteadded central line-associated bloodstream infections in intensive care units to its list of publicly reported quality of care measures for individual hospitals.
Why is this so important? There is universal support for the idea that the U.S. health care system should pay for value rather than volume, for the results we achieve rather than efforts we make. Health care needs outcome measures for the thousands of procedures and diagnoses that patients encounter. Yet we have few such measures and instead must gauge quality by looking to other public data, such as process of care measures (whether patients received therapies shown to improve outcomes) and results of patient surveys rating their hospital experiences….
- Hospital Quality Compare (Centers for Medicare & Medicaid Services)- compares quality of care for certain medical conditions at more than 4,200 hospitals. The site also includes a checklist to help you choose a hospital
- Leapfrog Hospital Ratings – information on this site is derived from hospitals’ voluntary submissions of The Leapfrog Hospital Survey. More about the Leapfrog Group at their About Page
- AHRQ (US Agency for Health Care Research and Quality
- Medicare.gov includes
- Doctor Rating Web Site Health Grades is a Time Magazine “Best 50″ – How Trustworthy Is the Content?? (jflahiff.wordpress.com)
- Georgia hospitals rated on infections (ajc.com)
- Hospital Reviews Reflect Data On Hospital Outcomes (medicalnewstoday.com)
- The Cost of Satisfaction: A National Study of Patient Satisfaction, Health Care Utilization, Expenditures, and Mortality (bespacific.com)
- Surgical Outcomes-Based Measures Developed: Approval Marks Latest Step In Path To National Implementation (medicalnewstoday.com)
- The Leapfrog Group names Children’s Memorial a top children’s hospital for patient safety (prweb.com)
- The Leapfrog Group Names Virginia Mason Top Hospital of the Decade (prweb.com)
- Roswell Park Named to Leapfrog Group’s Annual Top Hospitals List (prweb.com)
- How patient satisfaction can kill (kevinmd.com)
- American Health Care System Gets Positive Prognosis In “U.S. Health Care: The Good News” February 16, 2012 At 9 P.M. Est On PBS With Correspondent T.R. Reid (prweb.com)
- National Quality Forum endorses 2 American College of Surgeons NSQIP measures (eurekalert.org)
- Skeptical Scalpel: Patient satisfaction and reality (gruntdoc.com)
- Nurse Navigators Providing Patient Satisfaction at Medical Center (prweb.com)
- Hospital Caregivers use MagnaSnap Paper Clamps at Bedside to Improve Patient Satisfaction Scores (prweb.com)
- Requiring doctors to give orders on patients they have not seen (kevinmd.com)
Dr. Mohammodieza Hojat and a multidisciplinary team at Jefferson Medical College in Philadelphia have previously published 5 articles validating an objective and reproducible measure of empathy exhibited by physicians in the context of medical education and patient care. They hypothesized that a physician’s empathy would positively effect clinical outcome, not just patient satisfaction.
To test their theory, they chose patients with diabetes, a chronic disease that requires frequent engagement between patient and doctor, much patient education and communication as well as strict compliance to designated treatment protocols. Moreover, there are definable and easily measurable indicators of improved clinical outcomes. Appropriate statistical controls were used to separate the effect of empathy from other know determinants of outcome such as gender, age and socioeconomic status.
They followed 891 diabetic patients for 3 years and conclusively showed that physicians’ empathy itself resulted in a 40-50% improvement in the measured results. Finally, in their concluding remarks, the researchers acknowledged any limitations to their methodology, but stated that their results do provide sufficient evidence warranting replication of this line of investigation at other institutions and with a variety of diseases….
- Doctors can learn empathy through a computer-based tutorial (eurekalert.org)
- Is medical school an empathotoxin? (mindhacks.com)
- We need to talk about Kevin’s lack of empathy (guardian.co.uk)
- ¿Do you have empathy? (vae20.wordpress.com)