The Joint Commission (an accrediting body formerly called JCAHO) has adopted national patient safety goals for 2022. Goals apply to Ambulatory Care and Office-Based Surgery, Behavioral Health Care, Hospitals (including Critical Access Hospitals), Home Care, Laboratories, and Nursing Care Centers (Long Term Care). The simplified versions are quick for consumers to read and understand.
AHRQ, the Agency for Healthcare Research and Quality, is one of 12 agencies within the Department of Health and Human Services. It is the lead Federal agency charged with improving the safety and quality of America’s health care system. Its mission is to make health care safer, higher quality, more accessible, equitable, and affordable. It also works to help people understand that evidence and put it into practice. FY22 budget is $455 million.
The AHRQ Hospital Survey on Patient Safety Culture now has 2.0 results for 2021. The 2021 survey shows an overview of findings from 172 hospitals. Survey results are from 87,856 hospital staff members (47% avg. response rate). While teamwork within units, and supervisors promoting safety received relatively high marks, the staffing and pace of work for staff, as well as handoffs and information exchange, were identified as weaker areas. Staff expressed concerns about having enough staff to handle the workload, and about staff working longer hours than would be best for patient care. Nursing assistants scored the staffing and pace items the lowest. Less than half of staff were positive about hospital’s management being interested in patient safety all the time – not just after an adverse event happens; RNs were particularly critical of this. Staff also scored transferring patients from one unit to another lower, because of important information often being left out. Pharmacists and pharmacy techs scored this last item the lowest.
Some of the lowest scores came from people working on Med/Surg units, Emergency Departments and ICUs. On a composite basis, Administration and Rehab/Physical Therapy scored culture the highest. See Charts 5-1 and 5-2 for the overview. Detailed breakouts by position and department are in the appendixes. Published by the Agency for Healthcare Research and Quality, AHRQ, March 2021. Survey results for 2021 using the 1.0 survey tool are also available, from 320 hospitals and almost 192,000 staff.
Surveys on Patient Safety Culture (SOPS) can also be accessed from this AHRQ web page for medical offices, nursing homes (see listing below), community pharmacies and ambulatory surgery centers.
Just how good is US healthcare? Compare the United States with Canada, Australia, France, Germany, Netherlands, New Zealand, Sweden, UK and many other countries on longevity, key healthcare performance measures, and non-medical determinants such as smoking and obesity. 2021 interactive database shows relative actual scores from OECD’s international 2019 and 2020 results. Older results are also shown. In general, the database is complex due to its detail. Many people will have difficulty finding the higher level comparisons they wish. Trends in health expenditures as a percent of GDP are shown. The US outranks all at 16.8% share of GDP. An interesting comparison is that the US topped all other countries with 42.8% measured obesity in the total population in 2019, compared to the next countries of Mexico and Chile at 34-36% (2016-2018 data). Find obesity under Non-Medical Determinants of Health. Countries like Japan and Korea came in at a 5-6% range. Updated November 2021.
The latest 2021 National Healthcare Quality and Disparities Report (QDR), focuses on hundreds of measures of the quality of healthcare in the US. Midwestern states Minnesota, North Dakota, Wisconsin and Iowa; Northeastern states Maine, Massachusetts, New Hampshire, and Rhode Island; western states Colorado and Utah; and North Carolina and Kentucky had the highest overall quality scores, 2015-2020. Across all measures of health care quality, about half of the measures had improved performance. Pace varies by area. In the first half of 2021, 14% of people ages 18 to 64 were uninsured at the time of the interview. Published December 2o21.
The AHRQ Nursing Home Survey on Patient Safety Culture shows staff opinions in the 2019 database. Survey results from over 10,000 nursing home staff members (52% avg. response rate) in 191 participating nursing homes provide a baseline on the safety culture for residents in US nursing homes. While overall perceptions of resident safety, feedback about incidents, and supervisors promoting safety received relatively high marks, there were a number of low-scoring areas. Nursing home staffing received the lowest ratings of any category, especially having enough staff to handle the workload, and having to hurry or use shortcuts because staff have too much work to do. Perceptions that staff are blamed when a resident is harmed, and staff opinions being ignored in their nursing home also were lower-scoring areas. See Charts 5-1 and 5-2 for the overview. Detailed breakouts by position and type of nursing home are in the appendixes. In general, large nursing homes of 200 beds or more scored the lowest; staff at nursing homes with under 50 beds tended to score items the highest. Only 44% of staff at large nursing homes gave an overall rating on resident safety of “excellent” or “very good”. Breakouts of opinions held by nursing assistants compared to other employee groups are enlightening. Published by the Agency for Healthcare Research and Quality, AHRQ, February 2019.
Many resources can be found at AHRQ’s Patient Safety Network website. In the redesigned site, you may have to dig to find what you’re looking for, but it is worth the effort to try. One of our favorite pages is the All Topics page for adverse events and other safety problems, shown here. There are a number of case studies and many journal articles. Includes studies and reports from the National Health Service of the United Kingdom. The Agency for Healthcare Research and Quality is a federal agency.
This article, Patients’ ratings of hospital care are associated with technical quality of care, concludes that patient experience is generally correlated with the quality of care provided. Study was based on a study of 4605 hospitals in 2011. Article by Stein, Day, et al, published in the American Journal of Medical Quality, April 2014. Full article linked.
Find a list of Quality Improvement and Innovation Organizations – QIOs. The mission of the QIO program is to improve the effectiveness, efficiency, economy, and quality of services delivered to Medicare beneficiaries. It has been modified to incorporate Quality Innovation Networks and complaints on behalf of patients and beneficiaries. Find a Quality Improvement Organization here, searchable by state. Updated 2022.
A new report shows data on hospital readmissions within 30 days following an initial hospitalization. In 2018, the readmission rate for all payers combined was about 14 per 100 admissions. The average cost was $15,200. For a private insurance patient, the readmission rate was lower, but the average cost was higher, at $16,400. Charges would have been higher, but are not shown. Hospital readmissions are an important measure for assessing performance of the health care system. One strategy for improving health care quality and lowering costs is to reduce rates of preventable readmissions. High numbers of return to hospital occurred for septicemia. The second most common category was heart failure. The highest rate (36.1%) was for sickle cell trait/anemia. For Medicaid readmissions associated with sickle cell, the cost was close to $20,000 HCUP Statistical Brief #278 was published by AHRQ July 2021.
ACHE annual survey asked hospital CEOs to identify their top three issues of concern in 2021. The overwhelming number one choice was Personnel shortages. For the first time since 2004, Financial challenges was bumped from the #1 concern, coming in second. Within personnel shortages, concerns were highest for RNs, followed by technicians and therapists. The biggest financial challenge was increasing costs for staff, supplies, etc. The third-ranked concern was Patient Safety and Quality, where concerns included cost/reimbursement for medications, engaging physicians in quality/safety culture, and redesigning care processes. Behavioral Health and Addiction issues slipped to 4th, tied with Governmental Mandates. Response rate 23%, by the American College of Healthcare Executives. Updated February 2022. The 2020 survey was suspended due to the pandemic.
The Patient Safety chartbook is part of the National Healthcare Quality and Disparities Report. It shows the progress made on lowering infections, hip or knee replacement adverse events, adverse drug events, cardiac bypass readmissions, home health care improvement, frequency of safety issues in medical offices, and patient safety culture. Rates shown to 2018 (in some cases, data only to 2017; ambulatory surgery center and medical office culture surveys data are from 2019, reported in 2020). Published February 2021 by AHRQ.