PROFESSIONQuality changes by hospitals aren't across the boardA time-series study shows quality of care improving, but an analysis of Medicare data reveals performance gaps between regions as well as within individual facilities.By Kevin B. O'Reilly, amednews staff. Aug. 15, 2005. Two studies that appeared in the July 21 New England Journal of Medicine came to starkly different conclusions about how well hospitals are implementing evidence-based standards of care for heart attacks, congestive heart failure and pneumonia. Hospitals significantly improved on 15 of 18 quality-of-care measures over the course of two years, according to a study of 3,377 hospitals conducted by researchers at the Joint Commission on Accreditation of Healthcare Organizations. But the second study showed that there are huge gaps in quality of care across regions in implementing relatively simple treatments such as giving heart attack patients aspirin at admission and discharge or vaccinating pneumonia patients to prevent a reoccurrence. The Boston-area medical researchers who conducted that study using data collected under the Medicare Modernization Act of 2003 also found that hospitals excelling in one area didn't necessarily do well in others. "I think these studies demonstrate that quality measurement and quality reporting is here to stay," said Robert Wachter, MD, chief of medicine at the University of California, San Francisco Medical Center. "The science of the field has advanced to the point where we can make reasonable assessments of quality based on standardized measures." Dr. Wachter, editor of the online patient safety journal AHRQ WebM&M, said that outcome-based measurement is valuable but imperfect because it's difficult to get an "apples-to-apples" comparison of hospitals, thanks to varying patient populations. He said the JCAHO study demonstrates that "the act of public reporting focuses the attention of providers on improving quality of practice." [...]Full text of American Medical News content is available to AMA members and paid subscribers.
Copyright 2005 American Medical Association. All rights reserved.
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