Showing posts from April, 2012

Not documented, not done. Really?

It is important to find ways to accurately understand what occurs during medical care. Reviews of medical records and patient surveys are commonly used as proxies for actually being inside an exam room and observing the visit.

But before we use these methods to figure out what happens during a patient visit, we first need to make sure that what we measure reflects what actually happened.

Counseling for nutrition and physical activity for children is a quality measure in the Healthcare Effectiveness Data and Information Set, a widely used set of performance measures in the managed care industry. Such counseling also is a criterion for “meaningful use” of electronic health records under the American Recovery and Reinvestment Act

My colleagues and I published a study last month that found the parental report via the use of a questionnaire administered immediately following their child's visit is a more valid method of assessing physician counseling on weight, nutrition and physical act…

Choosing Wisely

The U.S. spent $2.6 trillion on medical care in 2010. Despite spending much more on medical care than any other developed country, American medical care has mediocre clinical outcomes.

Open discussions between patients and their clinicians about tests and procedures can facilitate the delivery of the right care at the right time. As a pediatrician, I often see parents who come into my clinic with names of tests or procedures for their child that they have read or heard about. More frequently than not, these parents, when engaged in discussions on evidence-based recommendations, make decisions about their child's care that are reasonable, objective, and surprisingly more conservative than one might intuitively expect.

Earlier this month, nine medical societies in the U.S., representing 375,000 physicians released a 45-item list of commonly used procedures that they no longer recommend we automatically order. A major goal of these recommendations is to reduce wasteful spending withou…

Team spirit in health care

Robust interprofessional collaboration results in higher quality and safer care for our patients and improves health outcomes.

National organizations have recently focused on the imperative for interprofessional collaboration. In 2010, the Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health, offered recommendations that focused on improving health care through contributions from nurses. A key recommendation calls for nurses, physicians and other healthcare professionals to partner with each other in redesigning our health care system.

Developed by the Department of Defense and the Agency for Healthcare Research and Quality, the evidence-based program, TeamSTEPPS, helps optimize patient care by improving communication among healthcare professionals.

The Patient Protection and Affordable Care Act has a strong focus on engaging interprofessional teams to improve the quality, safety, and efficiency of health care.

There are multiple challenges to interprof…

Partnership for Patients turns one

In 1999, the Institute of Medicine's study, “To Err is Human,” estimated that up to 98,000 Americans die each year from preventable medical errors. An average of 1 in 3 patients suffer a medical error or adverse event during hospital care.

A year ago, in April 2011, the Department of Health and Human Services launched the Partnership for Patients. The Partnership brings together hospital leaders, employers, health care providers, patient advocates, and state and federal governments toward the achievement of common goals of better care and lower costs. More than 7000 hospitals, physicians, nurses, health plans, consumer groups, and employers nationwide have since pledged their commitment to this initiative.

Up to a billion dollars of federal funding from Affordable Care Act has been committed towards 2 initial goals over next 3 years: Reducing preventable injuries in hospitals by 40% and reducing hospital readmissions by 20%.

Nearly $250 million was awarded to 26 state, regional, na…

"Hot spotting" in healthcare

The United States spends about $2.5 trillion on health care annually. Health care spending is highly concentrated... just 5% of the population accounts for almost