Best U.S. hospitals are run by physicians, study finds

From the 6 July 2011 Science Daily item

 Top-performing hospitals are typically ones headed by a medical doctor rather than a manager. That is the finding from a new study of what makes a good hospital.The research, to be published in the elite journal Social Science and Medicine, is the first of its kind. Its conclusions run counter to a modern trend across the western world to put generally trained managers — not those with a medical degree — at the helm of hospitals. This trend has been questioned, particularly by the Darzi Report, which was commissioned by the U.K. National Health Service, but until now there has been no clear evidence….

Going ‘Green’ May Cut Hospital Costs

Going ‘Green’ May Cut Hospital Costs
Even surgical staff can reduce waste without harming patients, study says

 

 

From the February 22 Health Day news item by Robert Preidt

MONDAY, Feb. 21 (HealthDay News) — Implementing practical, environmentally friendly practices in operating rooms and other hospital facilities could reduce health-care costs without compromising patient safety, says a new study.

In the United States, health-care facilities are a major source of waste products, producing more than 6,600 tons per day and more than 4 billion pounds a year. Nearly 70 percent of hospital waste is produced by operating rooms and labor-and-delivery suites.

Operating rooms have energy-sucking overhead lights and it’s common for OR staff to open sterilized equipment that is never used, and to fill red bags that are labeled as medical waste with harmless trash that could be disposed of more cheaply, said the Johns Hopkins researchers.

“There are many strategies that don’t add risk to patients but allow hospitals to cut waste and reduce their carbon footprints,” study lead author Dr. Martin A. Makary, an associate professor of surgery at the Johns Hopkins University School of Medicine, said in a Hopkins news release.

He and his colleagues reviewed research on hospitals’ environmental practices and then convened a panel of experts to create a list of practical eco-friendly strategies that could be used in operating rooms.

The top five strategies were: cutting down on and separating operating room waste; reprocessing single-use medical devices; considering the environment when making purchasing decisions; improving energy consumption; and improved management of pharmacy waste.

The study appears in the February issue of the journal Archives of Surgery.***

 

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Homeless people without enough to eat are more likely to be hospitalized

Homeless people without enough to eat are more likely to be hospitalized
Mass. General study is first to document association between food, use of health services

From the February 3, 2011 Eureka news release

Homeless people who do not get enough to eat use hospitals and emergency rooms at very high rates, according to a new study. One in four respondents to a nationwide survey reported not getting enough to eat, a proportion six times higher than in the general population, and more than two thirds of those had recently gone without eating for a whole day. The report will appear in the Journal of General Internal Medicine and has been released online.***

“The study is the first to highlight the association between food insufficiency and health care use in a national sample of homeless adults,” says lead author Travis P. Baggett, MD, MPH, of the Massachusetts General Hospital (MGH) General Medicine Division. “Our results suggest a need to better understand and address the social determinants of health and health-care-seeking behavior,”

Baggett and a team of investigators at MGH and the Boston Health Care for the Homeless Program analyzed survey data from 966 adult respondents to the 2003 nationwide Health Care for the Homeless User Survey. They found that homeless people who did not have enough to eat had a higher risk of being hospitalized in a medical or psychiatric unit than did those with enough to eat and also were more likely to be frequent users of emergency rooms. Neither relationship could be explained by individual differences in illness. Nearly half of the hungry homeless had been hospitalized in the preceding year and close to one-third had used an emergency room four or more times in the same year.

Baggett explains the study was sparked by his clinical experience caring for homeless individuals. “Homeless patients with inadequate food may have difficulty managing their health conditions or taking their medications. They may postpone routine health care until the need is urgent and may even use emergency rooms as a source of food. Whether expanding food services for the very poor would ameliorate this problem is uncertain, but it begs further study.” Baggett is an instructor in Medicine at Harvard Medical School.

 

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Electronic medical records not always linked to better care in hospitals, study finds

From the December 23, 2010 Eureka News Alert

Use of electronic health records by hospitals across the United States has had only a limited effect on improving the quality of medical care, according to a new RAND Corporation study.

Studying a wide mix of hospitals nationally, researchers found that hospitals with basic electronic health records demonstrated a significantly higher increase in quality of care for patients being treated for heart failure.

However, similar gains were not noted among hospitals that upgraded to advanced electronic health records, and hospitals with electronic health records did not have higher quality care among patients treated for heart attack or pneumonia.

The findings, published online by the American Journal of Managed Care, are part of a growing body of evidence suggesting that new methods should be developed to measure the impact of health information technology on the quality of hospital care…..

 

 

Better Methods Needed to Measure Hospital Quality: Experts

Better Methods Needed to Measure Hospital Quality: Experts
Using patient death rates to assess care found to be unreliable in Massachusetts study

From the December 23, 2010 Health Day news item by Robert Preidt

THURSDAY, Dec. 23 (HealthDay News) — Hospital-wide patient death rates may not be a reliable way to assess a facility’s quality of care, a new study indicates.

Researchers in Boston compared four measures of hospital patient death rates. They found that the measures yielded both higher- and lower-than-expected rates for the same Massachusetts hospitals for the same year.

The findings add to an ongoing debate about the value of using death rates as a measure of health-care quality, said lead author Dr. David M. Shahian, a Harvard Medical School professor of surgery at Massachusetts General Hospital (MGH), and colleagues.

“It’s troubling that four different methods for calculating hospital mortality rates as a measure of quality should yield such different results. Measurement theory — not to mention plain common sense — suggests that there is a problem,” Shahian said in an MGH news release….

….

The researchers told the state they could not recommend any of the four vendors’ tools.

“But the results should not be interpreted as an indictment of any particular technique,” study co-author Sharon-Lise T. Normand, Harvard Medical School professor of health care policy (biostatistics) and a professor of biostatistics at Harvard School of Public Health, said in the news release.

Instead, Normand said, the findings “call into question the concept of measurement of hospital-wide mortality, as four different methods yielded four different results. Thus, this may not be a good way to assess hospital quality.”

The study results are published in the Dec. 23 issue of the New England Journal of Medicine.

SOURCE: Massachusetts General Hospital, news release, Dec. 22, 2010

 

Related MedlinePlus Pages

• Choosing a Doctor or Health Care Service
• Health Facilities

Related AHRQ Web pages (US Agency for Healthcare Research and Quality)

• Mortality Measurement
• Measuring Healthcare Quality

 

 

 

 

Hospital perks: How much should hospitals be rewarded for the patient experience?

From a Decemer 2, 2010 Eureka news alert

From hotel-style room service to massage therapy to magnificent views, hospitals are increasingly touting their luxury services in a bid to gain market share, especially those in competitive urban markets. An important new article, published today in the New England Journal of Medicine, raises crucial questions about the role of amenities in hospital care, explaining that how we decide to value the patient experience can have a significant effect on health care costs. “Though amenities have long been relevant to hospital competition, they seem to have increased in importance — perhaps because patients now have more say in selecting hospitals,” explained corresponding author John Romley, an economist with the Schaeffer Center for Health Policy and Economics at USC and research assistant professor in the USC School of Policy, Planning, and Development. Empirical evidence and surveys seem to confirm that patients increasingly value the nonclinical experience more than measures of clinical quality, such as a hospital’s risk-adjusted mortality rate. In a “Perspectives” piece in New England Journal of Medicine, the authors cite their own research showing that Medicare patients often do not choose the hospital nearest to them. They are willing to travel — and not necessarily for better clinical care, even in cases involving heart attack, where risk of death should be an overriding concern. Rather, the proportion of patients who received care at a given hospital was strongly correlated to the quality of amenities. Improved perks also have a significant effect on hospital volume. “On a societal level, the value of amenities is important because our health care system currently pays for them,” explained lead author Dana Goldman, director of the Schaeffer Center at USC and Norman Topping Chair in Medicine and Public Policy at the USC School of Policy, Planning, and Development. “A hospital seeking to strengthen its financial position might view investment in amenities as a sound strategy to attract patients. The question is, however, what effect such a strategy might have on patients’ outcomes as well as on overall health care costs.” The researchers note that if amenities create environments that patients and providers prefer, the result may be better treatment and improved health outcomes. Accounting for patient experience can either help us determine whether amenities are necessary to better performance or tell us if hospitals should shift their focus entirely to clinical quality instead. “As health care reform moves forward, we need to decide whether amenities are a valuable part of the hospital experience,” Romley said. “If they are, policymakers should include them in the measures for overall quality, prices and productivity.” ### Mary Vaiana at RAND was also an author of this paper. Goldman, et al. The Emerging Importance of Patient Amenities in Hospital Care. New England Journal of Medicine. December 2, 2010.

Medicare finalizes new rules to require equal visitation rights for all hospital patients

From the November 17, 2010 US Department of Health and Human Services news release (http://www.hhs.gov/news/press/2010pres/11/20101117a.html)

The Centers for Medicare & Medicaid Services (CMS) today issued new rules for Medicare- and Medicaid-participating hospitals that protect patients’ right to choose their own visitors during a hospital stay, including a visitor who is a same-sex domestic partner.

“Basic human rights—such as your ability to choose your own support system in a time of need—must not be checked at the door of America’s hospitals,” said HHS Secretary Kathleen Sebelius.  “Today’s rules help give ‘full and equal’ rights to all of us to choose whom we want by our bedside when we are sick, and override any objection by a hospital or staffer who may disagree with us for any non-clinical reason.”

The new rules follow from an April 15, 2010 Presidential Memorandum, in which President Obama tasked HHS with developing standards for Medicare- and Medicaid-participating hospitals (including critical access hospitals) that would require them to respect the right of all patients to choose who may visit them when they are an inpatient of a hospital.  The President’s memorandum instructed HHS to develop rules that would prohibit hospitals from denying visitation privileges on the basis of race, color, national origin, religion, sex, sexual orientation, gender identity, or disability.  It also directed that the rules take into account the need for a hospital to restrict visitation in medically appropriate circumstances.

The rules require hospitals to have written policies and procedures detailing patients’ visitation rights, as well as the circumstances under which the hospitals may restrict patient access to visitors based on reasonable clinical needs.

A key provision of the rules specifies that all visitors chosen by the patient (or his or her representative) must be able to enjoy “full and equal” visitation privileges consistent with the wishes of the patient (or his or her representative).

The rules update the Conditions of Participation (CoPs), which are the health and safety standards all Medicare- and Medicaid-participating hospitals and critical access hospitals must meet, and are applicable to all patients of those hospitals regardless of payer source.

Among other things, the rules impose new requirements on hospitals to explain to all patients their right to choose who may visit them during their inpatient stay, regardless of whether the visitor is a family member, a spouse, a domestic partner (including a same-sex domestic partner), or other type of visitor, as well as their right to withdraw such consent to visitation at any time.

“These rules put non-clinical decisions about who can visit a patient out of the hands of those who deliver care and into the hands of those who receive it,” said CMS Administrator Donald Berwick, MD, MPP.  “While we still have miles to go in making care more patient-centered, these rules make it easier for hospitals to deliver on some of the fundamental tenets of patient-centered care—care that recognizes and respects the patient as an individual with unique needs, who treated with dignity and granted the power of informed choice.”

CMS finalized the rules based on thousands of comments from patient advocates, the hospital community, and other stakeholders.  The rules will be effective 60 days after publication.  More information about the rules is available on CMS’ website at http://www.cms.gov/CFCsAndCoPs/06_Hospitals.asp and http://www.cms.gov/CFCsAndCoPs/03_CAHs.asp.

 

How To Complain—And Get Heard (at the Hospital)

From a March 17, 2009 advice column by Carolyn M. CHow To Complain—And Get Heardlancy, MD, appearing in AHRQ (US Agency for Healthcare Research and Quality)

Whether it’s a car repair that didn’t fix the problem or a bad meal in a restaurant, many of us don’t hesitate to complain. Making our voices heard when something isn’t right is the first step in getting it corrected. But when we’re sick or need health care services, it’s hard to know where to direct a complaint. And it can be difficult to question people who may know more than we do, especially when we aren’t feeling well.

These reasons are valid, but they shouldn’t be obstacles. As a physician, I’m encouraged that consumers are becoming more comfortable asking their medical team questions. I hope this continues.

Hospitals and health groups have tried to make it easier for patients to raise concerns or complaints. But it’s still not easy to do. Health services are delivered in many different settings and are often not coordinated from one place to the next. So it’s up to the patient or his or her family to identify where to make a complaint and to follow through and report the problem.

A very helpful Government resource, called the Beneficiary Ombudsman, is available for people covered by Medicare or Medicare health plans. This Web site can serve as your first stop to learn how these and other Government programs work and how to file a complaint or an appeal.

People who are covered by private insurance should review the information they get when they enroll to find out who to contact when they have complaints.

Here are some resources for complaints or concerns that arise:

While you are in the hospital: If possible, first bring your complaints to your doctor and nurses. Be as specific as you can and ask how your complaint can be resolved. You can also ask to speak to a hospital social worker who can help solve problems and identify resources. Social workers also organize services and paperwork when patients leave the hospital.

If you are covered by Medicare, you can file a complaint about your care with your State’s Quality Improvement Organization (QIO).  These groups act on behalf of Medicare to address complaints about care provided to people covered by Medicare.

Typical complaints QIOs handle are getting the wrong medication, having the wrong surgery, or receiving inadequate treatment. You can also find your QIO by calling 1-800-MEDICARE.

If you get an infection while you are in the hospital or have problems getting the right medication, you can file a complaint with the Joint Commission. This group certifies many U.S. hospitals’ safety and security practices and looks into complaints about patients’ rights. It does not oversee medical care or how the hospital may bill you.

To find out what other patients had to say about their recent hospital stays, visit the Hospital Compare Web site. You’ll find answers from patients about how well doctors and nurses communicated, how well patients’ pain was controlled, and how patients rated their hospital.

If you are discharged before you’re ready: This is a big concern for many patients because insurers balk at long hospital stays. Talk to the hospital discharge planner (often a social worker) if you don’t think you’re medically ready to leave the hospital. The discharge planner will take your concerns to the doctor who makes this decision.

If you are covered by Medicare or by a Medicare managed care plan, you can file an appeal about a discharge while you are still in the hospital. You should get a form from the hospital titled “An Important Message from Medicare,” which explains how to appeal a hospital discharge decision. Appeals are free and generally resolved in 2 to 3 days. The hospital cannot discharge you until the appeal is completed.

When you get your hospital bill: First, ask your doctor or the hospital’s billing department to explain the charges. Find out how the hospital handles complaints about bills, and make your case. If you still have questions, you should contact the Medicare carrier that handles billing issues for your Medicare program.

You can also call 1-800-MEDICARE about billing questions. Make sure you have the date of service, total charge in question, and the name of your doctor and hospital.

Even with this information, it’s not easy to be as assertive in a health care setting as it is in an auto repair shop or restaurant. But it’s a smart move that can help you get the quality care that you deserve.

I’m Dr. Carolyn Clancy and that’s my advice on how to navigate the health care system.

More Information

Agency for Healthcare Research and Quality

Questions Are the Answer: Get More Involved With Your Health Care

http://www.ahrq.gov/questionsaretheanswer/

American Health Quality Association

Quality Improvement Organization (QIO) Locator

http://www.ahqa.org/pub/connections/162_694_2450.cfm

The Joint Commission

Report a Complaint about a Health Care Organization

http://www.jointcommission.org/GeneralPublic/Complaint/

Department of Health and Human Services

Beneficiary Ombudsman: Inquiries and Complaints

http://www.medicare.gov/Ombudsman/resources.asp

Department of Health and Human Services

Hospital Compare—A Quality Tool Provided by Medicare

http://www.hospitalcompare.hhs.gov/Hospital/Search/Welcome.asp

Department of Health and Human Services

Medicare Appeals and Grievances

http://www.medicare.gov/basics/appeals.asp

Department of Health and Human Services

Helpful Contacts

http://www.medicare.gov/Contacts/Include/DataSection/Questions/SearchCriteria.asp

Current as of March 2009

Hospital Preparedness Checklist for Pandemic Influenza

Hospital Preparedness Checklist for Pandemic Influenza (with a 2009 focus)  aims to help “enhance the readiness of the health facilities to cope with the challenges of an epidemic, a pandemic or any other emergency or disaster, hospital managers need to ensure the initiation of relevant generic priority action. [The document]  aims to provide a checklist of the key action to carry out in the context of a continuous hospital emergency preparedness process.”

This 32 page PDF document includes checklists in the areas of incident command, communication, continuity of essential services, surge capacity, human resources, logistics, and supply management (including pharmaceuticals), infection prevention and control, case management, surveillance, and laboratory services.

 

Hospital Collaboration May Boost Surgical Patient Safety

Sharing data on successful medical practices helped cut complication rates, study found

From a Health Day News Item

By Robert Preidt
Monday, October 18, 2010

MONDAY, Oct. 18 (HealthDay News) — The rate of surgical complications decreased nearly 10 percent at 16 Michigan hospitals after they began to share information about what methods they use to keep patients safe, a new study has found.

Among the 300,000 study patients who underwent general and vascular surgery between 2005 and 2007, the reduction in ventilator-associated pneumonia alone could save $13 million a year in health care spending, the findings indicated.

The program, called the Michigan Surgical Quality Collaborative, is led by the University of Michigan.

“The collaboration of hospitals in terms of identifying and disseminating information about best practices is actually a much more effective way of improving quality than just relying on each hospital alone to come up with what they think is a way to improve quality,” study author Dr. Darrell A. Campbell Jr., a professor of surgery and chief medical officer at the University of Michigan Health System, said in a university news release.