Category Archives: Quality

Hitching our Wagon to the Stars: Making the Most of Quality Reporting

The Centers for Medicare and Medicaid Services (CMS) has a set of “Compare” websites – Hospital Compare, Nursing Home Compare, Home Health Compare, etc.; consumers and policymakers can compare physicians, long-term care hospitals, inpatient rehabilitation facilities, hospice care, and dialysis facilities today, and other settings may follow. Together with their associated health care quality measurement… Read More »

Improving the Patient Care Experience among Persons of Varying Race, Ethnicities, and Languages

Improving the overall patient care experience is an essential focus for organizations as healthcare delivery continues to evolve. The US Department of Health & Human Services Agency for Healthcare Research and Quality (AHRQ) notes patient experience as an integral component of healthcare quality, which includes “several aspects of healthcare delivery that patients value highly when… Read More »

Barriers to Care Among American Indians

American Indians (AIs) typically have poorer health outcomes than any other racial or ethnic minority group in the United States. This includes an increased risk for cancer, diabetes, injury related mortality, and infant mortality.  AIs tend to have the highest rates of poverty and low rates of insurance coverage. Much of the AI population uses the Indian… Read More »

Preventing Health Care that Almost Nobody Needs

Medicine, alongside achievements in sanitation and public health, remains one of the major achievements of modern society. The reduction (or eradication) of many infectious diseases from the developed world, breakthroughs in anesthesiology and surgery, and advances in the care of chronic diseases (including HIV) are just a few of the multitudes of achievements. But these… Read More »

Reducing Ambulatory Malpractice and Safety Risk: Results of the Massachusetts PROMISES Project

Every physician fears being sued. Almost half of primary care doctors are subject to a malpractice lawsuit at some point in their careers. In some quarters, physicians are fatalistic about this fact. I have heard colleagues say: “It’s going to happen at some point, I know it.” But since the publication of the Institute of… Read More »

Cancer care: sometimes less is more

Cancer is a dreaded disease – and in the US, a typical response to a cancer diagnosis is to try every treatment available in hopes that something might work. Understandable! But cancer overtreatment is a serious problem that drives up costs, causes avoidable morbidity and mortality, and reduces the quality of care. What is overtreatment?… Read More »

Problems with Epilepsy Drug Treatment for Older Adults

Expensive brand-name drugs are prescribed over older, less costly generics whose efficacy and risk profiles aren’t much different. Sometimes the financial issues involved are painfully obvious, such as when a drug company introduces a new, “improved” version of a medication that is merely a longer-acting version of the same chemical entity shortly before the patent expires on the original… Read More »

Trying to Reduce Unnecessary Emergency Visits? First, Strengthen Our Primary Care System

Emergency departments (EDs) nationwide are busy places. In some locales they are overcrowded. In places like Los Angeles and other dense, urban areas with high poverty, they are over-capacity to such an extent that they can grind to a halt for all but the highest priority cases. In years past, it was not unheard of for… Read More »

Smoking cessation treatment among newly covered individuals under the ACA

Smoking cessation is not innovative or trendy or even particularly exciting, but as a primary care doctor, in most cases helping a patient quit smoking is the best thing that I can do to help that patient over their lifetime. Without question. And for that reason, I always make it a priority to talk about it… Read More »

Avoiding Anticholinergic Drugs May Reduce Alzheimer’s Risk

I’ll never forget the time Granddaddy tried to eat my hand. At least that’s how it seemed to me at age six. In reality, he’d simply confused my hand with the straw sticking out of the milkshake we’d brought to him at the nursing home. By that point in his early-onset Alzheimer’s disease, the Granddaddy… Read More »

Primary Care is a Team Sport

One remedy for the looming shortage of physicians in the United States is expanding the caregiver workforce to include nurse practitioners (NPs) and physician assistants (PAs). These health professionals come from fairly disparate backgrounds, yet over the years, increasing numbers of them have practiced side by side with physicians in primary care and specialty settings… Read More »

Discrimination in Trans Healthcare and the Call for Further Provider Education

Adequacy of healthcare for transgender patients has recently come to light, particularly with the increased discussion of trans persons in the media. Trans individuals identify their gender differently from their assigned sex at birth. Trans healthcare is an emerging field of research, and this increased focus continues to uncover the lack of knowledge amongst providers… Read More »

One Step Ahead: A Composite Measure to Capture Critical Hospice and Palliative Care Processes

The Centers for Medicare and Medicaid Services (CMS) wants to empower consumers to make informed healthcare decisions. CMS also wants providers to improve the quality of care they provide. One step towards accomplishing both of these goals is by public reporting of quality measures (QM). However, with multiple quality measures focusing on different care processes–all of which… Read More »

The HOSPITAL Score – A Prediction Tool for Potentially Preventable (and Therefore Costly) Readmissions

In the era of value-based care, caregivers and policymakers alike are intensely interested in strategies to reduce 30-day hospital readmissions. Researchers continue to offer up helpful tools in this effort. Recently published online ahead of print in Medical Care, Burke and colleagues make an important contribution with their article The Hospital Score Predicts Potentially Preventable 30-Day Readmissions… Read More »

Continuity of Care vs. Nurse Shift Length

If you have ever been in a hospital, you are probably familiar with what seems like a continuously revolving door of staff members providing care.  With nurses making up the largest occupation in healthcare and the largest segment of hospital staff, continuity of nursing care for hospitalized patients is an important factor in the delivery of quality healthcare.… Read More »

Burnout among physicians and nurses

Private practitioners are busy people between caring for their patients, recording and documenting data, going to meetings, keeping up with new treatment modalities, and running a practice group. They follow a tight schedule, have multiple sources of pressure, and suffer from burnout. Stress occurs when a person is drained of energy, but can recover. In the case of… Read More »

How do Medical Errors Affect Healthcare Professionals?

In 1999, the Institute of Medicine released a report called To Err is Human. This report estimated that 44,000 to 98,000 hospitalized patients die each year as a result of preventable medical errors. But how do medical errors affect healthcare workers? A recent article by Van Gerven and colleagues, published ahead of print in Medical Care, addresses that… Read More »

Tools to improve coordination in primary care

Last month, I left readers with a bit of cliffhanger: How do we actually improve care coordination? Last time, I suggested there were some great ideas, and now it’s time to delve into three promising strategies: 1) individualize and personalize the electronic medical record (EMR); 2. fix the hospital discharge process; and 3) make it a part of normal practice to measure care coordination. Read on for more about each of these tools…

Quality Measurement in Home Care: Avoiding Unintended Effects

In theory, quality measurement and reporting generally benefits patients and their families, as (PDF link) public data on quality increases transparency and provider accountability. It also may benefit providers as a tool for quality assurance and improvement; however, the evidence does not always provide a clear picture. Unique challenges exist for patients receiving home care… Read More »

Feasibility of MDS 3.0 in Constructing Meaningful End-of-Life Quality Measures

Since the launch of Nursing Home Compare (NHC) in 2002, consumers have had access to information about the quality of care provided by most nursing homes (NHs) throughout the country. The intention is to help consumers distinguish among NHs and motivate informed decision making based on quality. For NHC to be useful, the quality measures… Read More »

Access to Care for US Latino Children in Traditional and Emerging Latino Communities

About one-quarter of all children born in the United States today are of Latino origin. Over the last twenty years, the under-18 US Latino population has grown rapidly – a result of both immigration and higher fertility rates among Latino adults relative to other groups. The Latino population more than doubled in 9 states between 2000 and… Read More »

Pressure ulcers: risk factors and the power of policy

Medical Care has recently published two papers on the topic of pressure ulcers — costly, painful, largely preventable infections associated with poorer quality care. In the first, from researchers at the University of Manitoba, York University, and the University of British Columbia, lead author Malcolm Doupe, PhD and colleagues focus on the risk of developing stage… Read More »

Factors associated with better performance on quality indicators for ACOs

Accountable Care Organizations (ACOs) are groups of health care providers, including doctors, hospitals, and other service providers, who provide coordinated care, reducing the need for patients to manage coordination of their own care. These organizations receive incentives from Medicare when they deliver care to patients efficiently. Providers make more money if they keep their patients healthy. Medicare… Read More »

Who Treats Medicaid Patients?

Who treats Medicaid patients? And is the quality of care provided by these individuals the same as you might expect from a clinician who takes only private insurance? An article in the April 2016 issue of Medical Care sought to answer these questions.

Although more than 92% of physicians reported seeing at least one Medicaid patient in 2011, the median proportion of Medicaid patients, for both PCPs and specialists, was less than 6%. This suggests that a small group of providers is responsible for seeing the majority of patients with Medicaid coverage…

As a current medical student, this research struck a nerve, particularly because of the emphasis on IMGs and medical school ranking. … What is more important to me is to understand what I, as a future primary care provider, can do. How do I ensure that people with Medicaid coverage get timely and appropriate referrals to specialty care? How can I expand my provider network to better equip them with the tools they need to ensure their long-term, lasting health?

Families rate independent and nonprofit nursing homes higher on patient experience

If you had to find a nursing home for a loved one, would you pick an independent, non-profit facility over a facility that was affiliated with a large, for-profit chain? If you said yes, your instincts are good. Independent and non-profit nursing homes are rated higher by patients and their families on the experience of their care. Kai… Read More »

Racial Disparities in Ambulatory Care Sensitive Admissions

Using 2003-2009 Agency for Healthcare Research and Quality (AHRQ) hospital discharge data from 6 geographically and demographically diverse states, Mukamel and colleagues found that African Americans continue to experience poorer quality primary care, especially for chronic conditions.