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THE FEDERAL GOVERNMENT RATES HEALTHCARE QUALITY IN MAINE (4/12/05)
WHAT YOU SHOULD KNOW
Healthcare quality in Maine is usually better than average. Each patient must be aware of how to protect themselves and their family from the hazards and failings of healthcare.
The Agency for Healthcare Research and Quality released information describing healthcare quality in individual states in April. The report measures healthcare quality using a widely accepted definition of quality.
People need to know certain things about their healthcare. They need to know if healthcare is available when they need it. They need to know if the healthcare offered works. They need to know if they are getting the healthcare that fits their own values and is understandable to them. The report did not try to measure value for the dollar.
Is there someone there to care for me when I need help
Information is incomplete but when we look at patients covered by Medicare in Maine, they have average wait times for appointments for routine care and care for acute illness and injury.
Are my doctor and I successful in trying to keep me healthy?
In Maine, do people usually get the care that helps prevent illness? Maine was ranked 12th in the U.S. on checking blood cholesterol in adults. Maine was 1st in the U.S. in checking stool for blood to detect colon cancer. We were 7th in providing needed prenatal care.
Does the care I get work? Do I get the care I need?
Maine ranked 47th in providing a medication after heart attack that experts believe patients should get. It is the opinion of the Maine Quality Forum that this particular result is misleading. There is a new medication that experts now agree is as effective and the AHRQ data does not measure for the new medication. MQF believes that given Maine’s high rating on other parts of heart attack care that this indicator demonstrates that Maine physicians are in the lead, not failing to provide an indicated care.
Maine providers do fall down when treating pneumonia. We are below average in getting antibiotics into patients as soon as we should and more often than not we do not give the proper antibiotics. Patient should be aware that when antibiotics are prescribed for a serious infection, it is important to get the antibiotics quickly, at least within four hours.
When we look at death from cancer Maine does poorly. The numbers however, show that we have many cancer deaths in part because we have a lot of cancer. Maine has a higher rate for lung cancer, colorectal cancer, prostate cancer and lower rate for breast cancer.
What do patients think of their healthcare providers?
We only have data from patients covered by Medicare. In Maine providers rated above average in spending enough time with their patients and above average in rating their healthcare a 9 or 10 where 10 is the best.
SO WHAT DOES THIS ALL MEAN?
Maine’s healthcare providers are performing generally above average when we measure the big picture. However, we know that healthcare providers in the United States perform poorly when compared to other rich countries in the world particularly when we measure prevention and basic care. When we add in the very high cost of care in the United States, the value is unsatisfactory.
As a patient, you need to know what preventive care to expect. Your provider should be helpful in this search. You need to know in detail how your healthcare provider performs on a daily basis. That information is not yet available. Healthcare is complex and extensive making measurement difficult. The Maine Quality Forum is one of the many organizations working on your behalf to improve healthcare quality and safety. We work with patients, providers, purchasers and health plans to measure and report what is actually happening within the healthcare system. Please be aware that everyone in healthcare wants you to be safe and get what you need. However, if you participate in your care you are more likely to be safe and get what you need. I hope that this information will help you.
The Maine Quality Forum
QUALITY DATA ABOUT MAINE HOSPITALS NOW ON THE WEB (4/2/05)
The Centers for Medicare and Medicaid Services (CMS) have launched their website HOSPITAL COMPARE. This website allows the user to select Maine hospitals to compare the care of heart conditions and pneumonia. The web site is interactive and allows the user to design the comparison they want.
The Maine Health Management Coalition also now shows quality information on its website using the same indicators. The MHMC web site has a more complete presentation of the data with the Maine average for comparison.
The viewer must understand that both of these efforts are new and extremely important. Each site will become more valuable as information is collected over time. Each website has text that explains the presented information.
PROTECT YOUR HEART – PROTECT YOUR BRAIN (3/29/05)
Most of us fear dementia, losing our memory and reasoning ability, more than we fear dying from a heart attack. Many physicians have thought that since many heart problems and many brain problems result from blood vessel disease such as atherosclerosis (fatty deposits in the wall of the blood vessel) then what is good for the heart is good for the brain.
New studies following patients with easy access to healthcare now confirm that patients with risk factors at middle age, (high blood pressure, high cholesterol, unhealthy high weight, diabetes and smoking) “substantially increases risk for dementia in old age”(Whitmer, Kaiser Study).
You need to realize the importance of this finding. Heart disease treatment has improved a lot. However, once you are on the road to dementia, (loss of brain function), the cause is lost. Only prevention works to teat dementia.
Talk to your physician about your risk factors. There are worse situations than death.
DIABETICS LOSE LEGS TOO OFTEN
The Wall Street Journal article by Michael McCarthy (2.23.2005) described the tragedy of 110,000 lower leg amputations in the United States in 2002. The number of amputations has increased from 99,522 in 1993. The article points out that the number of amputations in 2002 is more than double the number of recorded amputations in U.S. soldiers from the Civil War through the Viet Nam war.
Factors in the amputation epidemic include:
- More overweight baby boomers with diabetes
- At-risk patient who are ignorant of the care needed to prevent losing their legs
- Medical care that is not timely
What is the answer?
- Maintain a health weight
- If you are a diabetic, learn how to manage your diabetes aggressively to avoid the complications of diabetes
- Be aware that those at risk can lose a leg after a seemingly minor injury
- If your problem becomes serious, seek care from experienced physicians and surgeons who have been successful in saving legs
MINNESOTA AND MAINE REPORT ON SERIOUS REPORTABLE EVENTS IN HEALTHCARE
The National Quality Forum using its national voluntary consensus standards method developed a list of twenty-seven serious reportable events in healthcare. Many states now have laws requiring reporting of some or all of these events. Minnesota requires reporting all of the listed events. The Minnesota law went into effect in 2003. The first report covering 15 months was published January 19, 2005. It is available on the web at www.health.state.mn.us
During that period, 21 preventable deaths were reported. Eight deaths were caused by patient falls, five deaths caused by medication errors and four deaths caused by misuse or malfunction of a medical device. The report includes thirteen surgeries on the wrong body part, five surgeries were the wrong procedure and one surgery was on the wrong patient.
Maine also adopted a similar but less extensive statute in 2003. The Division of Licensing and Certification issued its Sentinel Event Report for calendar year 2004 to the Legislature this month. There were 15 reportable deaths and 4 wrong surgeries or surgery on the wrong body part. In Maine, a Sentinel Event Team from the Division of Licensure and Certification made an onsite visit for every reported event. Each institution also performed its own detailed investigation (root cause analysis). A failure of communication was the most frequently cited factor in a sentinel event. Failure to perform to standard of care (as widely accepted) was the second most frequent factor at 50%. Human factor (failure of training) contributed in 41% of the events.
WHAT DO I DO WITH THIS INFORMATION?
The Institute of Medicine and many other national organizations point out that these failures of care are system failures. In the very complex world of healthcare, bad events occur because systems are inadequate, poorly designed or not followed. Safety is a system quality with safety achieved by the organized effort of the extensive healthcare team.
Individual patients and families can help in the effort to make their healthcare safer. The Minnesota Report lists 12 steps you can take.
- Be involved in your own care.
- Chose a hospital experienced in your problem or procedure.
- Ask healthcare workers to wash their hands when appropriate.
- Make sure you understand the treatment plan at the time of discharge.
- Make sure you and your surgeon are clear about the operation to be done.
- Speak up if uncertain.
- Make sure one doctor is in charge of your care.
- Help make sure that all professionals have all of your health information.
- Try to have an advocate (family or friend) with you.
- More is not better. Make sure you need the treatment.
- Learn the result of every test; do not assume that no news is good news.
- Learn about your condition from many sources.
What is the Maine Quality Forum Doing to Help Support the continuous Improvement of Health Care Quality?
The Maine Quality Forum (MQF) supports the continuous improvement of health care quality in several ways. The MQF reports valid, reliable and useful provider performance information to the public to assist them in making informed choices when selecting health care services. The same information will be shared with providers to help them identify opportunities to continually improve clinical outcomes.
Second, the MQF will work with other health related groups, agencies and organizations in Maine to help inform providers of new methods and tools now available to assist with the quality improvement process. Examples include the MQF participation as a partner in the statewide Quality Counts initiative focused on improving care for patients with chronic illnesses such as diabetes, asthma, heart failure and others; and a proposal to aid physicians in establishing electronic medical records in their offices to improve patient safety and clinical outcomes.
A third initiative by the MQF and the Dirigo Health Agency Board is to fund and guide a plan to develop a statewide electronic health information system so that with the patient’s approval an individuals medical information can be shared among the physicians and hospitals involved in that patient’s care wherever the patient is receiving medical services. Such a system will provide the most current patient record to each physician actively involved in the patient’s care. The result will be markedly improved outcomes, enhanced patient safety, and less costly care by avoiding duplication of tests and treatments.
The MQF’s success in achieving the goal of supporting the continuous improvement of health care quality will be based on working collaboratively with all segments of the health care system and most importantly with the public. Our efforts are and will continue to be patient–centered. The ultimate result of working together to improve quality and the goal we all strive for will be the continually improving health status of the citizens of Maine.
Other Ways to Help Your Doctor and Hospital Improve Their Quality
INDIVIDUAL PHYSICIAN PERFORMANCE
Maine is the only state that is collecting the records of all the medical bills that have been paid by any insurer. These records are stored in a database that allows us to analyze the quality of care provided. The data collected will include the records of both commercial insurers and those who are self-insured. Medicaid and Medicare claims may be included. By the fall of 2004, the database will include the records from January 1, 2003 through March 31, 2004.
The Rand Corporation has a system for measuring the quality of health care. They believe the system will create useful information about the quality of care provided by individual providers.
Using either the Rand approach or something similar, The Maine Quality Forum expects to provide Maine citizens with physician-specific, quality data by early 2005.
HOSPITAL PERFORMANCE DATA
For some of the care they provide, Maine’s hospitals, in cooperation with the Maine Health Management Coalition and the Maine Quality Forum, are providing information about the medical care they provide and outcomes of that medical care. This information should be available on the MQF web site by late 2004.