2011 Potpourri XXXX

By October 14, 2011Commentary

A paper from the UCLA Center for Health Policy Research focuses on informal caregivers in California.  There are about 6 million of these people in California providing about 3.9 billion hours of care; many doing so for more than 20 hours a week.  Overall the health of these informal caregivers is the same as other people of the same age, but the caregivers report higher levels of psychological distress and stress and they engage in higher rates of unhealthy behavior.  Few of them appear to take advantage of programs designed to help with their caregiving tasks and to help them cope with stress.    (UCLA Paper)

An article in Health Affairs shows how relatively simple interventions can have a significant cost and quality impact in health care.  The intervention occurred at the Women’s and Children’s Hospital of North Carolina and focused on reducing infections, through three relatively simple and inexpensive methods, which largely involved awareness, education and simple things like hand-washing.  Following the interventions, on average patients spent 2.3 fewer days in the hospital, each hospitalization cost $12,136 less and mortality dropped by 2.3 percent.  Annual savings in just the one pediatric intensive care unit were projected at about $12 million.  (HA Article)

More bad news for designers of quality reporting and value-based purchasing programs.  Adding to other evidence that often what is measured doesn’t have any real impact on actual health outcomes, a study reported in the Journal of the American Medical Association looked at the relationship between asthma care quality measures and outcomes at children’s hospitals.  The outcomes were asthma related ER visits and readmissions within 7, 30 and 90 days.  No relationship was found between scores on the measures and these outcomes.  Two of the measures had very high compliance and little difference among hospitals, so it wasn’t really possible to test for a relationship.  The study suggests that it is pointless to make people go through the effort and expense of tracking and reporting on things that don’t appear to make a difference.  Even on the two “topped-out” measures, there would appear to be no possible affect on outcomes, since there is little variation on the measures, but there is variation in ER visit and readmission rates.    (JAMA Article)

Another Health Affairs article focuses on the need for “compassionate” care.  This is an interesting aspect of the patient experience category which has become a central part of CMS’s quality reporting and value-based purchasing initiatives.  Independent research has shown that the things that matter the most to patients in regard to their satisfaction are actually the empathy of the providers and the sense that providers care about them and what they are going through.    Other research suggests that patients who believe that empathy or compassion exists, may have better health outcomes.  These authors surveyed patients and providers and found that while both groups think compassionate care is important, many believe it is not often delivered.   (HA Article)

A perspective in the Journal of the American Medical Association discusses the uses of quality of care indicators for older adults.  The authors point out that while many care guidelines and resulting process measures may be well-meaning, they often must be revised because of subsequent evidence and they often aren’t equally applicable to all sub-groups in the patient population.  For very old adults in particular, great care must be taken in applying the quality measures too aggressively because older people have more fragile and easily disturbed biochemical and physical systems and are susceptible to unintended harms.  The authors suggest that countervailing quality measures that indicate when it might be inappropriate to use a diagnostic or treatment method should be developed and implemented.  (JAMA Article)

Kaiser Permanente had the Harris organization do a poll to see how well Medicare beneficiaries understood the Star quality rating system.  About 500 seniors were surveyed by phone.  Only 2% knew their plan’s rating, but 20% knew they could switch to a five star plan outside of normal enrollment periods.  Only about a third of those who knew of the Star rating system were using it to make decisions, and only a third have even heard of the system, so about 10% are using it.  Interestingly, high-income and more well-educated beneficiaries were less familiar with the program.   Poorer and less-educated seniors were most likely to use the data in making a plan choice.    (Harris Poll)

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