The Joint Commission (an accrediting body formerly called JCAHO) has adopted national patient safety goals for 2021. 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. FY20 budget is $444 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. 2020 interactive database shows relative actual scores from OECD’s international 2018 results. Older results are also 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% (2016-2017 data). Find obesity under Non-Medical Determinants of Health. Countries like Japan and Korea came in at a 4-6% range. Updated July 2020.
The latest 2018 National Healthcare Quality and Disparities Report (QDR), focuses on over 250 measures of the quality of healthcare in the US. Midwestern states Minnesota, North Dakota, and Wisconsin; Northeastern states Delaware, Maine, Massachusetts, New Hampshire,Pennsylvania, New Jersey, Rhode Island and West Virginia; and Colorado 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, but increased to 13.3% in 2018, not considered statistically significant. 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; (21% of middle income families and 11% for high income families spent more than 10% of their income.) Disparities persist, especially for poor and uninsured populations in all priority areas. Published September 2019
National Committee for Quality Assurance (NCQA) – the premier accrediting body for health insurance plans – annual State of Health Care Quality Report. Reports performance for over 1000 managed care HMO & PPO plans on measures of effectiveness (HEDIS) during 2019, in more than 50 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. Average member satisfaction and experience with getting the kind of care they expect (CAHPS) are also included. Aggregate data only. An example of the type of information found in this report: In 2019, about 45-47% 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. Updated Fall, 2020. Visitors are required to provide name and email address to NCQA.
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, 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, 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 2020.
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 of concern. 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. Second issue of concern was Personnel shortages, noting especially RNs and primary care physicians, along with technicians. The third-ranked concern was Behavioral Health and Addiction issues.The lack of appropriate facilities or programs in the community and lack of funding were among the behavioral health concerns. Government mandates such as CMS regulations and legislative uncertainty; and Patient Safety and Quality slipped to 4th and 5th respectively. Response rate 27%, by the American College of Healthcare Executives. Updated 2020.
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 2017 (in some cases, data only to 2016; nursing home and pharmacy culture surveys data are from 2018, reported in 2019). Published October 2019 by AHRQ.