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New Survey Compares Hospitals in Seven Key Areas

By Barbara Stiebeling, RN, MSN, Quality Improvement Project Leader

 

In the Institute of Medicine's (IOM) report, Crossing the Quality Chasm , a recommendation was made to develop a standardized national survey for the collection of information regarding consumers' experiences while hospitalized. The goal was to publish this information to assist consumers in the comparison and selection of hospitals. In 2002, the Agency for Healthcare Research and Quality (AHRQ) began the process of formulating this tool, to be known as H-CAHPS (Hospital-Consumer Assessment of Health Plans Survey).

 

Published initially in the February 5, 2003 Federal Register , the H-CAHPS has undergone rigorous testing and input from many sources including the general public, review of the literature, interviews, consumer focus groups, stakeholder input, public response to Federal Register notices and a three-state pilot project in Arizona, Maryland, and New York. In addition, AHRQ requested that the National Quality Forum (NQF) review and evaluate the tool using their consensus process. This was completed early in 2005 and endorsed by the NQF on May 13, 2005. The Centers for Medicare & Medicaid Services (CMS) released the final H-CAHPS survey instrument on November 4, 2005.

 

The final step before implementation is for the Office of Management and Budget to review and issue a Federal Register call for final comments. This comment period ends on December 7, 2005.

 

Unlike satisfaction surveys currently in use, the H-CAHPS survey asks the consumer questions about their experience while hospitalized. The questions are grouped into seven domains of hospital care:

• Communication with physicians
• Communication with nurses
• Responsiveness of hospital staff
• Pain control
• Communication about medications
• Environmental aspects (cleanliness, noise)
• Discharge information

The final product is a 27-item survey that includes 22 questions on the above domains and five demographic questions. Implementation will be through individual vendors, who received training on the tool in September 2005. Hospitals may customize the survey by including additional information to assist them with process improvement. The formal H-CAHPS survey information will be publicly reporting by participating hospitals through the National Quality Alliance. This voluntary reporting, found on CMS' Web site, http://www.hospitalcompare.hhs.gov , should appear in late 2006 or early 2007.

 

In Ohio, P. Mardeen Atkins, RN, MPA, CPHQ, Manager, Patient Safety and Satisfaction Monitoring for the Cleveland Clinic Health System, served as a member of the National Quality Forum's review task force. She reports the final tool is an excellent beginning for helping patients and families compare hospitals not only on clinical quality but also service quality.

 

A special thank you goes to P. Mardeen Atkins, RN, MPA, CPHQ, for her review and assistance in writing this article.

 

 

 

QualityNet Exchange Checklist for Hospitals

“The goal of QualityNet (QNet) Exchange is to help improve the quality of healthcare for Medicare beneficiaries by providing for safe, efficient exchange of information regarding their care. Established by the Centers for Medicare & Medicaid Services (CMS), QNet Exchange is the only CMS -approved site for secure communications and data exchange.” (Quoted from the QualityNet Exchange Web site ). The article outlines the enrollment process for QNet Exchange and other important features of this Web site.

 

 

 

 

Ohio KePRO Offers Free Cultural Sensitivity Training Modules

With growing concerns about racial and ethnic disparities in health care delivery and the need for healthcare systems to accommodate increasingly diverse patient populations, cultural sensitivity has become more and more a matter of national concern and attention. Your medical staff may already have experienced episodes of care where meeting the needs of culturally diverse patients was affected by communication issues.

 

Ohio KePRO invites your medical staff to join a select group of physicians in Think Cultural Health, a free self-learning, Web-based program. Principles outlined in the National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health Care were developed by the Office of Minority Health, under the U.S. Department of Health & Human Services. The program is supported by the American College of Physicians, the American Academy of Family Physicians, the American Medical Association, the National Medical Association, and the National Hispanic Medical Association.

 

These educational modules are designed to increase awareness of your own cultural beliefs and discover how cultural differences, language and literacy issues can and do impact the delivery of quality health care. The program is organized by three distinct themes: Culturally Competent Care, Language Access Services, and Organizational Supports for Cultural Competency.

 

Earn CME credits

Through a series of short tests, participating physicians will earn up to nine Category 1 CME credits after viewing various clinical cultural encounters presented in interactive vignettes. There are three modules in each theme, each providing instant on-line scoring and immediate certificate issuance.

 

Learning objectives for these courses are listed below:

• Improve your communication skills and relationship with patients.
• Increase your ability to provide culturally sensitive and competent care.
• Improve your patients' understanding of medical interventions.
• Add to your knowledge, skills, and attitudes toward diverse patient populations.

If your practice is ready to bridge the gap and champion a culture of change, we want to work with you! Ohio KePRO is ready to assist your efforts to complete the program, improve culture-specific data collection, reduce language and cultural barriers, and develop office policies and structures aligned with improving patient access and utilization of services. Visit www.ohiokepro.com and click on the “Think Cultural Health” button to gain access to the program. (Be sure to enter your information so we can help you track your success.)

 

Still not convinced?

Contact the Physician Practice Team at droffice@ohqio.sdps.org or 1-800-385-5080 to schedule an office presentation and to learn more about this exciting new initiative for ensuring culturally sensitive care. (Fall 2005)

 

 

Workgroup Addresses Concerns of Small Rural and Critical Access Hospitals

By Donna Moore, RN, MBA, CPHQ, Quality Improvement Project Leader

 

As you travel through Ohio you notice much diversity, from the fast pace of the cities in northeastern Ohio to the slower pace of the rural communities of southeastern Ohio. You notice the larger, teaching hospitals in central Ohio and the smaller rural hospitals in northwestern Ohio.

 

All hospitals in Ohio are dedicated to providing high quality care. No matter what the size, the barriers are often the same, including those involving human resources and finances. Yet some barriers are specific to the tertiary hospital and others are specific to the smaller rural, critical access hospital. Critical access hospitals (CAH) are acute care facilities generally serving the population of a smaller community or county. The hospital has a capacity of 25 beds or less and has cost-based reimbursement. These smaller facilities are less hierarchical and more connected to the community. They strive to provide the same high quality of care that tertiary facilities strive to provide.

 

Unique barriers

Recognizing the unique barriers faced by CAHs, Ohio KePRO partnered with the Ohio Department of Health (ODH) and Ohio Hospital Association (OHA) to form the Ohio Rural Hospital Flexibility Program Quality Improvement Workgroup. CAHs and small rural hospitals are encouraged to participate in the workgroup.

 

The Workgroup holds quarterly meetings. The kickoff meeting was held at Morrow County Hospital in Mt. Gilead, Ohio, in January 2005. Representatives from six of Ohio's 30 CAHs were present to discuss barriers in delivering quality health care as well as the strengths of the smaller hospitals. One common barrier identified was the need for staff to wear “multiple hats.” For example, the Quality Improvement Director often has other roles such as case management, risk management, infection control, and shift supervisor. On the positive side, small rural hospitals or CAHs have less hierarchy, allowing the opportunity for processes to be implemented in a shorter time frame.

 

The second meeting was sponsored by Doctors Hospital of Nelsonville where the focus was on abstracting medical records using the Centers for Medicare & Medicaid Services' (CMS) Abstraction and Reporting Tool (CART) and analyzing data. In response to concerns discussed at the meeting regarding JCAHO surveys for CAHs, a teleconference was provided with a speaker from OHA Continuous Survey Readiness (CSR) Program Hardin Memorial Hospital presented details about its successful Heart Failure Clinic at the third meeting sponsored by Defiance Regional Medical Center where there were representatives from 11 hospitals. The fourth quarterly meeting was held in October 2005 at Fayette County Memorial Hospital in Washington Court House. The focus of the meeting was on patient safety culture. The next meeting will be held February 1, 2006 at a location to be determined.

 

A goal of the workgroup is to share concerns and solutions. The listserv sponsored by Ohio KePRO has provided participants the opportunity to seek answers to common issues. Questions concerning restraints, permits, and swing beds have been discussed on the listserv by hospitals and other organizations.

 

Participation in the Workgroup is also available through the listserv and teleconferences. For more information concerning the Workgroup or to sign up for the listserv, contact Donna Moore at dmoore@ohqio.sdps.org, or call Ohio KePRO at 1-800-385-5080. (Fall 2005)

 

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Facts About Influenza Vaccine Efficacy in the Elderly

 

From the Centers for Disease Control and Prevention

A new report by T. Jefferson and colleagues (Cochrane Vaccines Field, Italy) titled “Efficacy and effectiveness of influenza vaccines in elderly people: A systemic review” was published in the September 22, 2005 online issue of The Lancet. This article presents findings from a review of 64 studies that evaluated the efficacy and effectiveness of influenza vaccines in people aged 65 years and older. Fifteen of the 64 studies looked at vaccine efficacy in elderly individuals not residing in long-term care facilities, and 29 studies involved vaccine efficacy in persons living in long-term care facilities. The Centers for Disease Control and Prevention (CDC), which did not collaborate on this study, is providing the information below to help address questions that may be raised in response to the publication of this report.

• CDC recommends influenza vaccination for people age 65 years and over and for all persons in long-term care facilities
  • These recommendations are in place because people age 65 and over and those in long-term care facilities are at increased risk for complications from influenza.
• Vaccination is the best way to protect people age 65 years and over from influenza and its complications.
  • Vaccine effectiveness is not 100%. Some older persons and persons with certain chronic diseases might develop less immunity than healthy young adults after vaccination and, thus, can remain susceptible to influenza infection and illness.
  • In general, the vaccine can be effective in preventing secondary complications and in reducing the risk for influenza-related hospitalization and death among adults aged 65 years and over with and without high-risk medical conditions (e.g., heart disease and diabetes).
  • Among elderly persons not living in nursing homes or similar long-term care facilities, influenza vaccine has been reported to be 30% to 70% effective in preventing hospitalization for pneumonia and influenza.
  • Among older persons who do reside in nursing homes, influenza vaccine is most effective in preventing severe illness, secondary complications, and deaths. Among this population, the vaccine has been reported to be 50% to 60% effective in preventing influenza-related hospitalization or pneumonia and 80% effective in preventing influenza-related death, although the effectiveness in preventing influenza illness often ranges from 30% to 40%. In years when the vaccine is not well matched to circulating influenza strains, vaccine effectiveness is often lower.
    • When interpreting the findings from the Jefferson et al. study, there are a number of things to keep in mind:
      • The study did demonstrate that influenza vaccine is effective in preventing complications and death from influenza in older persons, both in the community and in long-term care facilities.
      • The highest estimate of vaccine effectiveness (VE) against laboratory-confirmed influenza was in the only large randomized trial among the elderly. Reasons for a lack of effectiveness against virologically proven influenza in some of the other studies reviewed are unclear.
      • Nearly all of the studies in elderly are non-randomized studies. Results from such studies can be difficult to interpret because of biases inherent in them.
      • Influenza vaccines should be well matched to circulating wild viruses to offer the best possible protection.
      • As the authors indicate, lower estimates of VE are expected when the study outcomes are not specific to influenza (e.g., influenza-like illness, ILI, or ICD-9 codes for pneumonia). Such non-specific outcomes were used for most of the studies.
      • The study results suggesting that the influenza vaccine is more effective among nursing home residents than among community-dwelling elderly is unexpected and not consistent with other data, including information on immune response to vaccination.
      • In the U.S., in contrast to what is implied by the authors, influenza vaccination is higher among elderly persons with chronic conditions and highest among nursing home residents, which would tend to biased VE estimates lower rather than higher VE.
      • As the authors indicate, better influenza vaccines that offer more protection in older persons are desirable and a high priority for influenza researchers. (Fall 2005)

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CMS Requires Hospitals to Adopt New Cardiac Registry for Quality Data

 

The Centers for Medicare & Medicaid Services (CMS) has contracted with the American College of Cardiology (ACC) to collect nationwide data to learn more about the use of implantable cardioverter defribillators (ICDs) for primary prevention of sudden cardiac death among Medicare beneficiaries.

 

The ACC's National Cardiovascular Data Registry's (ACC-NCDR) ICD Registry was developed through a partnership between the ACC and the Heart Rhythm Society with support from the ICD manufacturing industry, private health plans and payers, and hospital groups. Hospitals will be required by CMS to transition their current ICD data reporting activities from Quality Network Exchange ICD Abstraction Tool (QNet) to the ICD Registry no later than April 1, 2006.

 

CMS plans to use the ICD Registry data, combined with QNet data, to answer questions about indications for ICD implantation in the Medicare population and how frequently the devices stabilize the electrical activity of the heart in different subgroups of patients.

 

To ensure that hospitals can begin using the ICD Registry before the ICD Abstraction Tool sunsets, hospitals must first contact ACC-NCDR no later than January 1, 2006, to begin the enrollment process. More information about the ICD Registry can be found at https://www.accncdr.com or by calling the ACC toll-free at 1-800-253-4636, extension 451. (Fall 2005)

 

The above article appeared in the November 10, 2005 issue of AHQA Matters. Reprinted with permission of The American Health Quality Association.

 

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Material Feedback Survey

Ohio KePRO is continuously working to improve the quality of care delivered to Medicare beneficiaries. We offer innovative products and services and educational resource materials to encourage and support continuous quality improvement.

In an effort to improve the effectiveness of Quality Matters, we would like you to take three to five minutes to complete the following survey. Participation is voluntary and all answers are confidential. Please fill out this survey at your convenience and click on the submit button to e-mail it back to Ohio KePRO. We appreciate your feedback.

 

Newsletter: Quality Matters (Fall 2005)

 

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