How Will Partnership for Patients Reduce Medical Harm?

Cheryl Clark, for HealthLeaders Media , April 21, 2011

"Look at the data from around the country," McCannon replied. "It will show you there's still enormous variation in practice; some places are able to reliably provide care that reduces the incidence of adverse events, but there are other places where that just isn't the case."

"We know that where organizations reliably introduce these best practices, they get good results. So what we're seeking to do is help them introduce these evidence-based practices and study what has worked in other places," said McCannon.

Progress will be systematically checked, McCannon says. "We'll track changes in all-cause and specific forms of harm by conducting retrospective chart audits of records from a random selection of facilities to study change in harm over time," with various interventions and through databases such as the National Healthcare Safety Network, that are already kept by either CMS or the Centers for Disease Control and Prevention.

Hospitals will be the first targets for these efforts with the aim to reduce these categories of harm:

1.     Adverse drug events

2.     Catheter-associated urinary tract infections

3.     Central line-associated bloodstream infections

4.     Injuries from falls and immobility

5.     Obstetrical adverse events

6.     Pressure ulcers

7.     Surgical site infections

8.     Ventilator-associated pneumonia

9.     Venous thromboembolism

10. Nearly two dozen other hospital-acquired conditions.

The results will not be risk-adjusted because no hospital will be publicly singled out, he says. The money will be awarded to organizations that make a good case that others can learn from their strategies.

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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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