HP 353: quality of healthcare (10/2)

Is the U.S. healthcare system considered the best in the world?

No. Despite advanced capabilkties, the US ranks poorly in overall health outcomes and life expectancy.

What are some strengths of the US healthcare system?

Neonatal intensive care and impatient coronary heart disease have significantly reduced mortality rates.

What is a major concern despite high U.S. healthcare spending?

Americans live shorter lives and have the most avoidable deaths compared to other industrialized nations.

How does US healthcare spending compare to other countries?

The U.S. spends the most on healthcare as a percentage of GDP but ranks low in performance.

What are the 2 primary reasons that the US has poorer healthcare outcomes than other industrialized countries?

Lack of access to care and practice variations.

What are the 4 major practice defects in U.S. healthcare?

Overuse, underuse of effective care, misuse/errors in medical care and inefficiency/waste.

What is overuse?

Excessive use of services like tests, procedures, and costly specialists beyond what is clinically appropriate.

Health systems associated with overuse...

...had a higher number of beds, more incorporated medical groups, were investor owned.

Health systems associated with lower overuse...

...were involved in teaching, had a higher burden of uncompensated care, more primary care physicians was strongly associated with less overuse

examples of underuse of effective care

Underuse of statins post-heart attack, controller meds in pediatric asthma due to cost

What is the estimated annual cost of preventable medical errors in the U.S.

$20 billion, with 200k+ deaths annually.

What are "never events"?

Serious preventable errors like wrong-site surgery or foreign objects left in patients, not reimbursed by Medicare/Medicaid.

Inefficiency and waste examples

Delays in operating room throughout, post-op intubation time, medical record availability.

How can computer technology improve health care quality?

Through reminders for underused care, CPOE to reduce errors in order entry, and better medical record access.

What are the 3 components of Donabedian's quality assessment model?

Structure, process, and outcomes

What does structure include?

Facilities, equipment, staffing levels, staff qualifications, resource (beds/staff) delivery system

What ensures that certain minimal standards are met in hospitals?

Accreditation of facilities: the joint commission, CARF commission on the accreditation of rehab facilities

What does process include?

Delivery of services, communication, respect, diagnosis, treatment, waiting time, and cost of services

What does outcomes include?

Recovery, mortality rates, patient satisfaction, health status, and disease incidence/prevalence.

Traditional approach to improving quality

Identifying problem outcomes and sanctioning (punishing) the "bad apples" (poor performers).

Continuous Quality Improvement (CQI)

Ongoing, constant effort to reduce waste, rework, and complexity. Talents of all workers are enlisted in the pursuit of better ways.

Clinical practice guidelines

Explicit (evidence-based) descriptions of preferred clinical processes.

Quality report cards

Tools to evaluate and compare health plans or institutions.

HEDIS

Healthcare effectiveness data and information set. Evaluates the quality of health plans operating in the U.S.

What is the goal of a HEDIS?

To compare performance and publicize that info to help clinicians improve clinical care and to counter financial incentives to restrict appropriate care

What are some HEDIS performance indicators?

Children immunized, mammograms, Pap smears, prenatal exams, eye exams for diabetic patients, osteoporosis screening, flu shots, BMI assessment

What is CAHPS

Consumer Assessment of Healthcare Providers and Systems allows patients to rate their health care experiences using surveys.

What is pay for performance (P4P)?

Medicare initiatives to improve care quality across all settings by linking payment to performance.

T/F: quality of US healthcare is not what it should be

True, the quality has been on the decline in recent years, and it is definitely not where it should be. But, it will receive increasing attention in the US in the coming years.

T/F: cost containment has captured the attention of US policymakers

True! Cost containment has captured the attention of US policymakers.