The Joint Commission (an accrediting body formerly called JCAHO) has adopted patient safety goals for 2019. 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. FY19 budget is $451 million.
Survey results from 382,834 hospital staff members (54% avg. response rate) in 630 participating hospitals in 2018 provide a baseline on the patient safety culture in US hospitals. While teamwork within units, and supervisors promoting safety received relatively high marks, handoffs and transitions, as well as nonpunitive response to errors were identified as weak areas. Just half of respondents indicated staff felt free to question the decisions or actions of those with more authority. Less than half of staff were positive about transferring patients from one unit to another (pharmacy and lab staff especially reported this as a major concern), or about hospital units coordinating with each other (Emergency, Anesthesiology and Psych/Mental Health staff ranked this the lowest). ER staff expressed concerns about working in crisis mode too often, trying to do too much too quickly. See Charts 5-1 and 5-2 and Tables 6-1, 6-2 for the overview. Detailed breakouts by position and department are in the appendixes. Published by the Agency for Healthcare Research and Quality, AHRQ, March 2018.
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. Interactive database shows relative actual scores from OECD’s international 2015-2016 results. Some 2017 results are shown. A few ready-made reports are available, such as spending per capita by country in 2017. However, in general, the database is complex due to its detail. Many people will have difficulty finding the higher level comparisons they wish. An interesting comparison is that the US topped all other countries with 40% measured obesity in the total population, compared to the next countries of Mexico and Chile at 33-34% (2016 data). Countries like Japan and Korea came in at a 4-6% range.
The latest NHQR report focuses on over 300 measures of the quality of healthcare in the US. Midwestern states Minnesota, North Dakota, and Wisconsin; Northeastern states Connecticut, Maine, Massachusetts, New Hampshire, Pennsylvania, and Rhode Island; and Colorado, Hawaii, and North Carolina had the highest overall quality scores. Across all measures of health care quality, most improved. Pace varies by area. Rate of uninsured has been fairly flat from 2015 to 2017. On Affordability, most affordability measures did not significantly improve. About 17% of people under age 65 had family health insurance premiums and out-of-pocket medical expenses that were more than 10% of their income. Disparities persist, especially for poor and uninsured populations in all priority areas. Pub. Oct. 2018
National Committee for Quality Assurance (NCQA) – the premier accrediting body for health insurance plans – annual State of Health Care Quality Report, 2018. Reports performance for over 1000 managed care HMO & PPO plans on measures of effectiveness (HEDIS) during 2017, in more than 40 health topics such as cancer screening, diabetes care, osteoporosis management, controlling high blood pressure, immunization rates, asthma care, COPD, diabetes, appropriate medications, maternity care, mental health follow-up and readmissions. Also reports averages for member satisfaction and experience with getting the kind of care they expect (CAHPS). Aggregate data only. An example of the type of information found in this report: In 2017, about 45% of Commercial health plan members who visited the emergency department for a mental illness, had a follow-up within 7 days of the ER visit. Report published December 2018.
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, linked 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, by Stein, Day, et al, published in the American Journal of Medical Quality, April 2014, concludes patient experience is generally correlated with the quality of care provided. Study based on a study of 4605 hospitals in 2011. Full article link
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, organized by region and area
Two reports show data on hospital readmissions within 30 days following an initial hospitalization. In 2016, the readmission rate for all payers combined was about 13.9 per 100 admissions. 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. Broadly speaking, the categories of most readmissions in 2016 were circulatory system diseases (over 750,000 readmissions) and digestive system diseases (almost 500,000). Both categories had readmission rates around 16%. Medicare patients age 65+ also had a 16% readmission rate. Mental health and behavioral disorders had a readmission rate close to 17% in 2016. To compare, the pregnancy/childbirth category had less than 4% readmission rate in 2016. An older report shows 2014 readmissions by principal diagnosis. High rates of readmission in 2014 for schizophrenia and other psychotic disorders (22.9%), and Congestive heart failure (23.2%). High numbers of return to hospital for septicemia, complications of devices, implants, or surgical procedures; diabetes, and COPD. HCUP Statistical Briefs #230 and #248 were published by AHRQ Oct. 2017 and February 2019, respectively.
ACHE annual survey asked CEOs to identify their top three issues. The overwhelming number one choice continues to be financial challenges with top concern about increasing costs of staff and supplies, and adequacy of Medicaid reimbursement. Two items tied for Second choice: Government mandates such as CMS regulations and legislative uncertainty; and Patient Safety and Quality. Personnel shortages and Behavioral Health issues came in 4th and 5th respectively. Population health management dropped to #10. Response rate 25%, by the American College of Healthcare Executives. Released January 2019
The Patient Safety chartbook is part of the National Healthcare Quality and Disparities Report. It shows the progress made on lowering infections, Obstetric and birth trauma, hip replacement adverse events, 30 day mortality for colorectal surgery, adverse drug events, home health care wound improvement, frequency of safety issues in medical offices, and patient safety culture. Rates shown to 2015 (in some cases, data to 2017). Published October 2018 by AHRQ.