Patients worse off with more-experienced docs?

From a 15 July 2011 Reuters health article

NEW YORK (Reuters Health) – In a study that flies in the face of common sense, sicker patients turned out to fare worse under the care of seasoned doctors than when newcomers to medicine looked after them.

According to findings in the American Journal of Medicine, patients whose doctors had practiced for at least 20 years stayed longer in the hospital and were more likely to die compared to those whose doctors got their medical license in the past five years.

The results highlight “issues that we have as a medical profession in keeping up to date” with the latest medical knowledge, said Dr. Niteesh Choudhry of Harvard Medical School, who was not involved in the new study. It is “a quality of care problem that has been recognized for five to 10 years,” he told Reuters Health….

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New Brief Outlines Strategies to Put Patients at the Center of Primary Care

From the press release

AHRQ has released a new brief, The Patient-Centered Medical Home: Strategies to Put Patients at the Center of Primary Care, highlighting opportunities to improve patient engagement in primary care.  The brief focuses on involvement at three levels: the engagement of patients and families in their own care, in quality improvement activities in the primary care practice, and in the development and implementation of policy and research related to the patient-centered medical home (PCMH).  Strategies to Put Patients at the Center of Primary Care provides a clear and concise definition of the patient-centered medical home and outlines six strategies that can be used to support primary care practices in their efforts to engage patients and families.  This brief and other resources, including white papers and a searchable database of PCMH-related articles, is available from AHRQ’s online PCMH Resource Center at PCMH_Patients at the Center of Primary Care (PDF File, PDF Help).

Related articles

• Health-care model improves diabetes outcomes, health (eurekalert.org)
• More On The Synergies Between the Patient Centered Medical Home (PCMH) and Remote Telephonic Disease Management (diseasemanagementcareblog.blogspot.com)

AHRQ Offers Interactive Tool To Analyze National and State Health Care Data

From the AHRQ (Agency for Healthcare Research and Quality) press release

Mining for specific data on health care quality and disparities in the U.S.?  It’s an easy process with AHRQ’s NHQRDRnet online query system, which features data from the 2010 National Healthcare Quality Report and the National Healthcare Disparities Report.  At the State and national level, you’ll find quality-of-care data on clinical conditions ranging from asthma and diabetes to heart disease and cancer.  You can review data by specific age groups as well as by race, ethnicity, income, and education.  Using NHQRDRnet’s search tool, you can locate data tables based on selected words, chapters, or type of table.  Select to access AHRQ’s NHQRDRnet system.

Related Link

• Improving Data Collection to Reduce Health Disparities (Healthcare.gov)

 

HHS Secretary Released the National Strategy for Quality Improvement in Health Care Report

From the AHRQ  (Agency for Healthcare Research and Quality) press release

HHS Secretary Kathleen Sebelius released the National Strategy for Quality Improvement in Health Care.  The Strategy was called for under the Affordable Care Act and is the first effort to create national aims and priorities to guide local, State, and national efforts to improve the quality of health care in the United States.  The National Quality Strategy will promote quality health care that is focused on the needs of patients, families, and communities.  At the same time, the Strategy is designed to move the system to work better for doctors and other health care providers – reducing their administrative burdens and helping them collaborate to improve care.  The Strategy presents three aims:

• Better Care: Improve the overall quality, by making health care more patient-centered, reliable, accessible, and safe.
• Healthy People & Communities: Improve the health of the U.S. population by supporting proven interventions to address behavioral, social, and environmental determinants of health in addition to delivering higher-quality care.
• Affordable Care: Reduce the cost of quality health care for individuals, families, employers, and government

To help achieve these aims, the Strategy also establishes six priorities, to help focus efforts by public and private partners.  Those priorities are:

• Making care safer by reducing harm caused in the delivery of care.
• Ensuring that each person and family is engaged as partners in their care.
• Promoting effective communication and coordination of care.
• Promoting the most effective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular disease.
• Working with communities to promote wide use of best practices to enable healthy living.
• Making quality care more affordable for individuals, families, employers, and governments by developing and spreading new health care delivery models.

The National Quality Strategy is designed to be an evolving guide for the Nation as we continue to move forward with efforts to measure and improve health and health care quality, and I hope that you will use it to guide your efforts to improve the quality and safety of health care services.  Select to read the National Quality Strategy.  Supporting documents are available on the AHRQ Web site.

Emory Healthcare’s unique training shows signific knowledge of quality principles

From the 11 April 2011 EurekaNewsAlert

ATLANTA – The effectiveness of a unique two-pronged educational program has shown significant improvements in knowledge of quality principles by leaders as well as the successful design and launch of QI (quality improvement) projects by frontline staff, according to results outlined in an article in the April 2011 issue of The Joint Commission Journal on Quality and Patient Safety (http://www.jcrinc.com/The-Joint-Commission-Journal-on-Quality-and-Patient-Safety/Current-Issue/).

[For suggestions on how to get this article for free or at low cost, click here]

Lessons learned from the program results, which originated at Emory Healthcare in Atlanta, should be useful to health care organizations as they weigh alternative strategies to promote QI activities and a culture of quality across their organizations, according to authors led by Dr. Kimberly Rask, MD, Ph.D, an associate professor in the Rollins School of Public Health at Emory University. The projects that were implemented as part of the practical methods course are being systematically evaluated for sustainability and longer-term impact on patient outcomes.

“This initiative shows the feasibility of implementing a broad-based in-house QI training program for multidisciplinary staff across an integrated health system. Initial assessment shows knowledge improvements and successful QI project implementations, with many projects active up to one year following the courses,” says Dr. Rask.

“The opportunity to improve quality and patient safety in health care settings has been well documented,” Rask adds. “Health care organizations use a variety of strategies to promote quality improvement activities, but there is little evidence to date about the most effective strategies. Studies have shown that clinically focused training in QI techniques can improve patient safety and reduce inefficiency.”

The project spanned five Emory hospitals and a multispecialty physician practice. One two-day program, ‘Leadership for Healthcare Improvement,’ was offered to leadership, and a four-month program, ‘Practical Methods for Healthcare Improvement,’ was offered to frontline staff and middle managers.

Participants in the leadership program completed self-assessments of QI competencies and pre- and post-course QI knowledge tests. Semi-structured interviews with selected participants in the practical methods program were performed to assess QI project sustainability and short-term outcomes. More than 600 employees completed one of the training programs in 2008 and 2009. Leadership course participants significantly improved knowledge in all content areas, and self-assessments revealed high comfort levels with QI principles following the training. All practical methods participants were able to initiate and implement QI projects.

Participants described significant challenges with team functionality, but a majority of the QI projects made progress toward achieving their aim statement goals. A review of completed projects shows that a significant number were sustained up to one year after program completion. Quality leaders continue to modify the program based on learner feedback and institutional goals.

 

 

Health Care Quality Still Improving Slowly, but Disparities and Gaps in Access to Care Persist

Health Care Quality Still Improving Slowly, but Disparities and Gaps in Access to Care Persist

From the Agency for Healthcare Research and Quality (AHRQ) Press Release

ress Release Date: February 28, 2011

Improvements in health care quality continue to progress at a slow rate—about 2.3 percent a year; however, disparities based on race and ethnicity, socioeconomic status and other factors persist at unacceptably high levels, according to the 2010 National Healthcare Quality Report and National Healthcare Disparities Report issued today by the Department of Health & Human Services’ (HHS) Agency for Healthcare Research and Quality (AHRQ).The reports, which are mandated by Congress, show trends by measuring health care quality for the Nation using a group of credible core measures. The data are based on more than 200 health care measures categorized in several areas of quality: effectiveness, patient safety, timeliness, patient-centeredness, care coordination, efficiency, health system infrastructure, and access.

“All Americans should have access to high-quality, appropriate and safe health care that helps them achieve the best possible health, and these reports show that we are making very slow progress toward that goal,” said AHRQ Director Carolyn M. Clancy, M.D. “We need to ramp up our overall efforts to improve quality and focus specific attention on areas that need the greatest improvement.”

Gains in health care quality were seen in a number of areas, with the highest rates of improvement in measures related to treatment of acute illnesses or injuries. For example, the proportion of heart attack patients who underwent procedures to unblock heart arteries within 90 minutes improved from 42 percent in 2005 to 81 percent in 2008.

Other very modest gains were seen in rates of screening for preventive services and child and adult immunization; however, measures of lifestyle modifications such as preventing or reducing obesity, smoking cessation and substance abuse saw no improvement.

The reports indicate that few disparities in quality of care are getting smaller, and almost no disparities in access to care are getting smaller. Overall, blacks, American Indians and Alaska Natives received worse care than whites for about 40 percent of core measures. Asians received worse care than whites for about 20 percent of core measures. And Hispanics received worse care than whites for about 60 percent of core measures. Poor people received worse care than high-income people for about 80 percent of core measures.

Of the 22 measures of access to health care services tracked in the reports, about 60 percent did not show improvement, and 40 percent worsened. On average, Americans report barriers to care one-fifth of the time, ranging from 3 percent of people saying they were unable to get or had to delay getting prescription medications to 60 percent of people saying their usual provider did not have office hours on weekends or nights. Among disparities in core access measures, only one—the gap between Asians and whites in the percentage of adults who reported having a specific source of ongoing care—showed a reduction.

Each year since 2003, AHRQ has reported on the progress and opportunities for improving health care quality and reducing health care disparities. The National Healthcare Quality Report focuses on national trends in the quality of health care provided to the American people, while the National Healthcare Disparities Report focuses on prevailing disparities in health care delivery as it relates to racial and socioeconomic factors in priority populations.

The quality and disparities reports are available online at http://www.ahrq.gov/qual/qrdr10.htm, by calling 1-800-358-9295 or by sending an E-mail to ahrqpubs@ahrq.hhs.gov.

For more information, please contact AHRQ Public Affairs: (301) 427-1892 or (301) 427-1855.

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