How Will Partnership for Patients Reduce Medical Harm?

Cheryl Clark, for HealthLeaders Media , April 21, 2011

The Obama administration's campaign to reduce hospital-acquired conditions by 40% and slash readmissions by 20% by 2013 seemed at first to be a publicity ploy lacking detail.

"Look here at all the harm being done; it's urgent that we tackle this problem head on," it seems to say. But that's okay.

The Partnership for Patients initiative announcement last week came right on the heels of CMS' frightening hospital-acquired conditions disclosure. The voluminous spreadsheet revealed exactly how many of each type of eight hospital-acquired conditions had occurred at each of the nation's 3,361 hospitals. Perhaps the timing of the two events was deliberate.

But the U.S. Department of Health and Human Services hasn't yet explained much about how it intends to track success rates for these badly needed improvements. For example, it hasn't

  • Provided a roadmap or instruction sheet to achieve the goals
  • Explained how it intends to track success rates for these improvements
  • Determined whether improvements should take place in the processes or actual outcomes and what metrics will be used
  • Provided clarity on who would review the data.

"I've been told the details will come," says David Classen, MD, author of the report in Health Affairs earlier this month that revealed hospitals are injuring as many as one in three patients receiving acute care because of avoidable errors.

His study pointed out that the safety metric traditionally used by half the hospitals in the country, the Agency for Healthcare Research and Quality's Patient Safety Indicators, or PSI, missed nine in 10, which were caught by the Institute for Healthcare Improvement's Global Trigger Tool.

 "This is all going to come to head, they're going to have to decide how they measure patient safety," he says.

I think that's a great idea. It's about time.

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Comments are moderated. Please be patient.

1 comments on "How Will Partnership for Patients Reduce Medical Harm?"

Bryan A. Liang (4/21/2011 at 1:30 PM)
Notwithstanding the theoretical benefits of Partnership for Patients, politics has ultimately played a significant role. As noted, the current initiative will *not* require public reporting of individual hospital performance. Rather than having each facility report results on reaching quality and safety targets, only aggregate goals and figures are to be used. Hence, potential strides for improvement of transparency and accountability in patient safety have been thwarted. Transparency is critical to any improvement in the safety realm, as is patient engagement in the process as a member of the safety team. Any safety initiative must, at a minimum, provide for individual hospital accountability through widely available public information about quality and safety measures within that facility. Moreover, patient-centered care and informed consumer choice can only be achieved through public reporting of patient satisfaction scores to demonstrate a facility's responsiveness to patients as the true center of the delivery process. Unfortunately, it is exactly these key indicia that have been removed from the initiative. Last year, when the initiative was supposed to be announced, consumer groups and large employer customers stressed public reporting was essential for individual hospitals to drive accountability and to supplant public value-based purchasing efforts with private-sector ones. Indeed, the administration solicited large employers (although not patients) for input regarding the initiative and tying payments to reporting and reaching quality measures. Instead of integrating input and promoting accountability by designing hospital systems that fulfill transparency, quality, and safety information needs, CMS This compromises the ethic of transparency, and the initiative actually represents two steps back in attempting to improve the current dismal state of patient safety. The dismal state of affairs of US patient safety means we need *more* accountability and *more* transparency, not less. Moreover, publicly reported scores at the website show that hospitals are receiving an F grade- scores of 55% or lower- for patients willing to recommend the facility to others, indicating an even greater need for individual hospital information. Patient access to safety, quality, and satisfaction information about individual institutions is the only road to informed consumer choice and thus improved accountability and competition. Innovative hospitals with outstanding quality and safety should not wait for CMS to change its approach. In parallel to advocating for accountability, these facilities should be trumpeting their transparency in open reporting of their patient safety and quality improvement activities compared with competitors. They should aggressively advertise their own high scores, and make direct comparisons to competing facility reported outcomes using available information. This approach can at least partially mitigate the impact of a policy that obscures how well facilities are actually performing. Transparency, accountability, quality, and safety[INVALID]these are all tenets constantly repeated by policymakers as their supposed focus in reform. It is time to clearly and unequivocally focus on the patient: The patient must have all relevant information to make an informed choice as to the facility that provides the highest quality and safest care with the best attention to patient experience and partnership. Quality and safety reporting for all providers is the foundational aspect of that focus. Patient safety advocates must ensure that policymakers are reminded that patients are entitled to safety and quality information as they remain the ultimate payers and the ultimate party who must shoulder the burden of poor healthcare quality and safety outcomes common in the United States health delivery system today. Bryan A. Liang, MD, PhD, JD, is Shapiro Distinguished Professor of Health Law and Executive Director, Institute of Health Law Studies, California Western School of Law; and Professor of Anesthesiology and Director, San Diego Center for Patient Safety, UCSD School of Medicine.




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