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Hospital Performance Improved But Are Measurements Accurate? September 17, 2011

Posted by jomaxx in : health care news, health care reform, health reform, Hospitals, medicine, patient care, Physicians, Public Health , add a comment

Is performance or reputation more important?

Does reputation equate to performance?

Are the data being measured of real patient care value?

A new report released by the Joint Commission on Accreditation of Hospitals (JCAH) suggests that on a variety of fronts hospitals are doing a better job of patient care. They looked specifically at five areas of care: heart attack, heart failure, pneumonia, surgical, children’s asthma.  The report shows that in terms of several quality measures, such as administering antibiotics in a timely manner to surgical or ICU patient, giving aspirin to heart attack patients on admission to the ER and the like, overall hospitals have improved in last couple of years.

The new report identifies 405 hospitals out of over 3,000 (14%) accredited by the JCAH.   Those selected had to achieve a compliance score of at least 95% in one or more of the five key areas monitored during this review.  Some hospitals achieved these scores in only one category, others in two, three or more.  The complete list has been published.

Of note is the finding that none of the 17 medical centers listed by U.S. News & World Report on its “Best Hospitals Honor Roll” this year are on the Joint Commission’s list of 405 hospitals that received at least a 95% composite score for compliance with treatment standards. About one-third of a hospital’s score in the U.S. News methodology is also based on its reputation as gauged by a survey of physicians.

The findings bring into question how deserving these institutions are of their reputations.  Still other measures of quality are out there including Medicare’s Hospital Compare site which lists among other things, mortality and morbidity rates for hospitals based on Medicare data.

It should also be noted that many hospitals that did not make this list still scored very highly and only missed the list by a few percentage points.  In fact it could well be that the difference in some cases was not performance at all, but simply lack of detailed documentation, which is really all JCAH and Medicare can go by in their respective data compilations.

The entire “science” of medical comparative outcomes is still really in it’s infancy, with many confounding factors needing to be considered and analyzed to achieve a true picture of outcomes and valid comparisons between facilities and treatments.  Still, it is clear that with increasing data collection, better analytical evaluation can be undertaken and a more informed patient and provider population will result.

Report Finds Improved Performance by Hospitals – http://is.gd/STHqr4

2010 Top Performers on Key Quality Measures – http://is.gd/YK09jV

Hospital Compare – http://is.gd/QfMaQ9

Joint Commission says physician outbursts threaten patient safety August 14, 2008

Posted by Obi Jo in : health reform , 1 comment so far

Well, it should come as no surprise that physicians and surgeons “act out” on occasion. The fact is that most of the time, the acting out is in response to inept, poorly trained, overworked, understaffed and underpaid medical staff, some of whom are often rude and lazy. In most cases, physicians are responding based on their concern for their patients. There is also an element of overwork, needless oversight, excess paperwork etc., etc., which play a role.

To be sure, there are physicians and surgeons who are well known for their “behavior”. However, while this may be undesirable and in some cases unacceptable, it is also unacceptable to create a climate where emotion, anger, frustration and intolerance for incompetence are stifled due to a desire by many for “politically correct” behavior and speech. Giving this kind of “thought control” to hospitals, health plans and insurance companies is unacceptable.

Actions alone, not words or emotions, should be the only criteria for judging physicians and surgeons. As is pointed out, some of the “worst offenders” in the eyes of hospital administrators and nurses are among the biggest admitters. Did anyone stop to think why those doctors might be in that position? Could it be that patients and the community know that those physicians take care of business and do not tolerate inferior care being given to their patients? The Joint Commission has for a long time been an organization whose mission has wandered farther and farther from real issues of patient care and this is just one more example of that . . . jomaxx

from the Boston Globe . . . The Joint Commission (JC), the national group that accredits healthcare organizations, “is requiring all hospitals, nursing homes, and other healthcare facilities to adopt ‘zero-tolerance’ policies by Jan. 1, including codes of conduct, ways to encourage staff to report bad behavior, and a process for helping and, if necessary, disciplining offenders.” An increasing amount of “research suggest[s] that swearing, yelling, and throwing objects are not just rude and offensive to co-workers, but hurt patients by increasing the likelihood of medical errors.” Last month, the JC “issued a safety alert to hospitals…, saying outbursts threaten patient safety because they prevent caregivers from working as a team.” According to Peter Angood, M.D., chief patient safety officer for the JC, “most hospitals have tolerated healthcare road rage to the point where it has become an accepted part of the culture.” Moreover, some say “[t]hat can be particularly true…in high-stakes surgery, a field that can attract high-intensity physicians who are used to being in charge.”

link to this article @ http://www.boston.com/news/local/massachusetts/articles/2008/08/10/hospitals_try_to_calm_doctors_outbursts/

from American Medical News. . . But, other physicians argue that “disruptive behavior policies, which can cover everything from criminal assaults to condescension, are often too vague, and [can be] used against physicians who may step on toes when advocating for patients, or who own competing specialty hospitals and ambulatory surgical centers,” Meanwhile, “[s]ome worry that the commission’s actions could make it easier for hospitals to target outspoken medical staff members.”

link to this article @ http://www.ama-assn.org/amednews/2008/08/18/prl20818.htm