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Other => Historical Posts => Topic started by: admin on September 25, 2009, 08:13:05 PM
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Advocacy
Joined: 19 Dec 2003
Posts: 1
Posted: Fri Dec 19, 2003 6:46 am Post subject: Healthcare Advocacy
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>PROFESSIONAL ISSUES<
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>Get tough on medical errors, conference told<
>Economist Uwe Reinhardt, PhD, calls on health care safety and quality activists to stop being so polite.<
>By Andis Robeznieks, AMNews staff. Dec. 22/29, 2003.<
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>Public pressure and government action are needed to make the health care industry more serious about improving quality and patient safety, and a better job of reporting health care issues by the media could ratchet up the pressure.<
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>That was the message delivered by speakers at the Joint Commission on Accreditation of Healthcare Organizations' recent "Decisions That Count" three-day conference on health care quality and patient safety in Chicago attended by physicians, nurses, attorneys and health care managers.<
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> With this article <
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>"The American media is failing us with health care," said Princeton University Professor of Political Economy Uwe E. Reinhardt, PhD.<
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>Dr. Reinhardt wondered what the public would do if news anchors mentioned in every
oadcast that "another 120 people died needlessly" that day because of medical errors or some other quality failure.<
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>He also declared that "the politeness has to leave the debate" and told the audience that they must get tough and not worry about being liked.<
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>But all people can expect the private sector to do is talk and "nibble at the edges," Dr. Reinhardt said, so it will be up to the government to make changes that will improve quality.<
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>80% of hands-on patient care in hospitals is delivered by someone other than a physician. <
>National Quality Forum CEO Ken Kizer, MD, said it's time to recognize that "health care is a team sport" and noted that 80% of hands-on patient care in hospitals is delivered by someone other than a physician. He said simple things can be done to improve quality such as serving more nourishing food, requiring caregivers to get flu vaccinations and making sure hospital staff wash their hands between patients. George J. Annis, who chairs Boston University's Dept. of Health Law, cited efforts to get doctors to wash their hands as an example of how low the quality bar has been set.<
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>Author and Robert Wood Johnson Foundation Senior Program Officer Rosemary Gibson called the 240 people in attendance "early adopters" and mentioned how some hospitals still discourage staff from applying for grants to study medical errors out of fear the research will put the institution in a bad light.<
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>"People are counting on you, and they are very, very grateful for your efforts," said Gibson, whose book Wall of Silence tells the stories of people and families affected by medical errors. "We need to change the public's norms about what's acceptable." She told the audience that they needed to start building a
oad base of public support if they wanted action to be taken. Gibson gave several recommendations on how to do this, including "putting a face" on the people affected by medical errors and getting people to evoke their own experiences regarding how medical errors have affected them or someone close.<
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>A traumatic mistake<
>Physicians are also affected by medical errors, and Arnold A. Zeal, MD, with the Jacksonville-based Neurosurgeons of North Florida, told his story during a one-day conference on eliminating wrong-site surgeries that JCAHO sponsored just before its conference on quality and safety.<
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>While performing a lumbar disc operation on another physician three years ago, Dr. Zeal was unable to find a bone fragment that had been causing the patient discomfort. Only after the surgery was completed did he realize he had operated on the wrong side of the patient -- who was immediately returned to the operating room after the error was discovered.<
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>Dr. Zeal said the patient didn't appear worse for wear from the incident and went home the next day, returned to work in two weeks, and was playing tennis again in three months.<
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>"The patient did fine -- probably better than I did," said Dr. Zeal, adding that he still has nightmares about the error and is embarrassed whenever he sees his former patient in a work or social setting.<
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>The incident was investigated by the Florida Board of Medicine, who ordered Dr. Zeal to pay a $10,000 fine and cover the cost of the investigation. He said he also was troubled by the fact that there was no effort made to prevent such an event from happening again.<
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Paste King
Joined: 19 Dec 2003
Posts: 1
Posted: Fri Dec 19, 2003 12:56 pm Post subject: BMJ
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BMJ] [The general medical journal website.]<
>> <
>> Home Help Search/Archive Feedback Table of Contents<
>> ------------------------------------------------------------<
>> BMJ 2003;327:1436-1439 (20 December),<
>> doi:10.1136/bmj.327.7429.1436<
>> <
>> Snakes,<
>> ladders,<
>> and<
>> spin<
>> <
>> How<
>> to<
>> make<
>> a<
>> silk<
>> purse<
>> from<
>> a<
>> sow's<
>> ear-a<
>> comprehensive<
>> review<
>> of<
>> strategies<
>> to<
>> optimise<
>> data<
>> for<
>> corrupt managers and incompetent clinicians<
>> <
>> David Pitches, specialist registrar1, Amanda Burls, senior<
>> clinical lecturer1, Anne Fry-Smith, information<
>> specialist1<
>> <
>> 1 Department of Public Health and Epidemiology, University<
>> of Birmingham, Birmingham B15 2TT2<
>> <
>> Correspondence to: D Pitches d.w.pitches@bham.ac.uk<
>> <
>> The introduction of performance league tables for UK<
>> surgeons and hospitals has forced them to learn how to<
>> present data in the best possible light. Though there is<
>> an urgent need for guidance, official guidelines on how to<
>> optimise performance data are lacking<
>> <
>> Surgeons' and hospitals' positions in league tables can<
>> make or
eak their reputations. They therefore need to<
>> learn how to present data in the best possible light.<
>> Although some may protest about "sexing up" poor<
>> performance data, "creative accounting" adds a positive<
>> spin. In contrast to the plethora of clinical guidelines,<
>> there is still no official advice on how to optimise<
>> performance data, and wide variations in practice persist.<
>> This review provides a timely, evidence based response to<
>> the urgent need for guidance.<
>> <
>> Methods<
>> <
>> We searched Medline for empirical examples of creative<
>> accounting (using the search terms "gaming", "mortality",<
>> "league table$", "upcoding", "fraud$", "quality", and<
>> "quality indicators, health care/") and identified 284<
>> papers, of which we reviewed the most relevant for<
>> suitable examples. We also searched the web with Google<
>> using "examples hospital healthcare fiddling figures." We<
>> included anecdotes from personal experience.<
>> <
>> Categories of creative accounting<
>> <
>> In addition to fraudulent or biased research, which has<
>> been thoroughly reviewed elsewhere,1 we identified three<
>>
oad categories of creative accounting:<
>> <
>> * Gaming of non-clinical performance data<
>> * Fraudulent reimbursement
claims<
>> * Gaming of clinical data.<
>> <
>> Manipulation of non-clinical performance targets<
>> This is particularly important for managers when meeting<
>> so called P-45 targets-an expression used by Tony Wright<
>> MP while examining Sir Nigel Crisp for the House of<
>> Commons Select Committee on Public Administration2 and<
>> meaning targets for which failure to meet can result in<
>> redundancy (in Britain the P-45 is the tax form people<
>> receive when leaving employment). A House of Commons<
>> investigation in 2002 uncovered strategies to
ing<
>> waiting times and numbers of patients waiting for<
>> treatment within national targets.3 Records were altered,<
>> patients were inappropriately suspended from waiting<
>> lists, and some hospitals did not report patients waiting<
>> longer than government targets. Though such techniques are<
>> readily exposed, one in 10 healthcare managers admitted to<
>> "fiddling figures" in a recent survey.4<
>> <
>> More intelligent managers inquire when<
>> patients intend to go on holiday and then<
>> offer an appointment during this period. Few<
>> patients cancel their holiday for medical<
>> reasons, preferring to postpone their<
>> appointment. Since the patients initiate<
>> these delays, their wait is no longer<
>> recorded. A related strategy offers patients<
>> non-existent appointments at impossibly<
>> short notice to attend; cancellation shifts<
>> them to the back of another list whose<
>> waiting times are not officially recorded.<
>> If you identify patients waiting longer than<
>> the permitted limit, you could arrange admission when<
>> their consultant is on holiday; then apologise profusely<
>> for the cancellation of their operation and offer a new<
>> date for surgery in the distant future.5<
>> <
>> In Scotland the waiting lists record only patients<
>> receiving inpatient care. To reduce the numbers of<
>> patients on published waiting lists you should ensure<
>> wherever possible that patients already offered inpatient<
>> treatment get treated as outpatients.6<
>> <
>> If you cannot place a patient on an unpublished waiting<
>> list, use the date you periodically update the waiting<
>> list, rather than the date of referral, as the starting<
>> point. This can knock several weeks off apparent waiting<
>> time.6 Variations include not placing patients on the<
>> waiting list until the month of their appointment or<
>> failing to reinstate previously suspended patients.<
>> <
>> We applaud advance warning of assessment, as this allows<
>> managers time to ensure that systems are in place to meet<
>> targets. We particularly commend the Department of Health<
>> for choosing one week each year to record waiting times in<
>> accident and emergency departments.7 Cancelling<
>> unnecessary operations and keeping extra beds open that<
>> week ensures your hospital meets the national target (90%<
>> of patients seen by a doctor within four hours of arrival)<
>> at least once a year. A BMA survey in 2003 found that 72%<
>> of accident and emergency departments introduced<
>> exceptional arrangements during the audit week, including<
>> hiring agency staff, introducing double shifts, and<
>> cancelling routine operations.8 This strategy proved<
>> highly effective at meeting government targets: during the<
>> audit week 85% of hospital trusts met the target, but the<
>> following week only 63% still met target waiting times.<
>> <
>> Another way to shorten waiting times in accident and<
>> emergency departments is to refuse to book in ambulance<
>> patients until your clinical staff are ready to assess<
>> them.5 Although patients are on hospital premises, you<
>> choose when to "start the clock," and until then the<
>> patients officially remain under the care of paramedics<
>> (jeopardising their performance targets instead of yours).<
>> <
>> Remember to "stop the clock" once you have transferred<
>> patients from trolley to bed since they have now been<
>> admitted (even if they remain in the department for the<
>> next two days). Once patients have seen a doctor,<
>> discharge them from the computer rather than wait for<
>> their transport to arrive and take them home.5 If your<
>> hospital is full, simply remove the wheels of a trolley to<
>> transform it into a bed, and erect a partition in the<
>> corridor to create an "observation ward."9<
>> <
>> Academic units are not immune from the need to enhance<
>> reputations by undertaking and publishing trials. If you<
>> cannot be bothered to do the research in the first place<
>> you may be able to persuade a journal to publish a trial<
>> under your name that has been conducted elsewhere and<
>> published in another journal. For example, it is<
>> intriguing that two randomised clinical trials comparing<
>> surgical techniques should include the same number of<
>> patients and find identical results, despite obviously<
>> being carried out in different hospitals on different<
>> continents.10 11<
>> <
>> Fraudulent reimbursement claims<
>> You should be aware of the various types of fraud<
>> described and prohibited by law in the United States and<
>> elsewhere. The False Claims Act prohibits misrepresenting<
>> the level of care offered or billing for services not<
>> rendered. The Anti-Kickback statute prohibits inducements<
>> with the intent to influence the purchase of healthcare<
>> services. Self referrals, in which physicians refer<
>> patients to facilities where they have a financial<
>> interest, are outlawed.12<