The purpose of this article is to drive attention to rising issues of quality care and patient safety in United States. In spite of launching major initiatives and investing heavily in recourses to improve patient safety, there has been no significant improvement in health care quality in past decade1. One of the challenges in measuring quality are developing accurate data system. Avoiding surgical complications by implementing WHO checklist guidelines, effective use of computerized physician order entry and electronic health records can foster safer, high quality care. Current state of quality and patient safety in USA
Americans too often do not receive care that they need, or they receive care that causes harm. Care can be delivered too late or without full consideration of a patient’s preferences and values. Providers frequently overuse therapies that are not known to be effective, underuse therapies that are clearly recommended, and misuse therapies. At best, overuse of care leads to inefficiency and waste. Overuse may also threaten patient safety. Underuse represents missed opportunities to prevent disease or treat it effectively, and misuse may threaten patient safety and lead to additional illness, injury, or even death. In December 1999, the institute of medicine reported that medical errors cause up to 98,000 deaths and more than 1 million injuries each year in the United States2.
From 2001 to 2005, total annual health care expenditure increased at a rate of 4.6 times the rate of the increase in the summery measure of quality of care. Annual total health care expenditures rose 6.5% (in 2005 dollars). During this time same period, quality increased at a rate of 1.4%. For heart disease, cancer and diabetes individually, quality increased at a rate of 2.6%, 1.9% and 0.1% annually, respectively. Expenditures increased at an annual rate of 4.4%, 9.0% and 4.9%, respectively3. Many times, our system of health care distributes services inefficiently and unevenly across populations. Some Americans receive worse care than other Americans.
These disparities may be due to differences in access to care, provider biases, poor provider-patient communication, or poor health literacy4. Disparities in quality of care are common: Blacks received worse care than Whites for 41% of quality measures. Hispanics received worse care than non-Hispanic Whites for 39% of measures. Poor people received worse care than high-income people for 47% of measures4. Challenge in quality measurement
Health care quality measurement has long been a troublesome issue. The first hurdle is deciding what to measure and how to measure it. Once performance measure topics and technical specifications are finally agreed on for a given healthcare setting, the next—and biggest—problem is getting accurate, complete data quickly enough to derive useful measurements. Primary review of medical records, which are still overwhelmingly paper-based records, is often the only way to collect data with the level of clinical detail needed to assess care. This is extraordinarily labor intensive. Data gaps represent an area of major concern to multiple stakeholders and encompass a diverse array of data elements.
Some data elements necessary to assess and improve quality of care are simply not available to those responsible for quality measurement and improvement activities both within and outside payer and/or care delivery organizations5. These data gaps are attributed to a number of different factors, including the burden of data collection; technology barriers to data collection; legal and/or technical barriers to sharing data among multiple clinicians or organizations involved in delivering or managing the care of a patient; and differing priorities among suppliers and users of the data5.
Another challenge to quality measurement is to ensure the accuracy of data used to provide information about quality. Inaccurate data may result from several sources including: random or inadvertent errors by data collectors, missing data, inconsistent use of definitions and criteria for inclusion, inappropriate aggregation of data, and systematic miscoding6. Improving Quality and patient safety
Surgical care and its attendant complications represent a substantial burden of disease worthy of attention. Surgical complications are a considerable cause of death and disability around the world7. Data suggest that at least half of all surgical complications are avoidable8. Previous efforts to implement practices designed to reduce surgical-site infections or anesthesia-related mishaps have been shown to reduce complications significantly8. A growing body of evidence also links teamwork in surgery to improved outcomes, with high-functioning teams achieving significantly reduced rates of adverse events8. Implementing the 19-item WHO safe-surgery checklist can significantly reduce surgical complications and morbidity. The checklist consists of an oral confirmation by surgical teams of the completion of the basic steps for ensuring safe delivery of anesthesia, prophylaxis against infection, effective teamwork, and other essential practices in surgery8.
Information technology had consistently been identified as an important approach for health quality improvement. Computerized physician order entry (CPOE) can improve medication safety, reduce adverse drug reactions, reduce unnecessary variation in care, and improving efficiency of care9. Widespread use of Electronic health records can transform health care. Benefits of E.H.R are: accurate, up-to date, and complete information about patients, quick access to patient records for more coordinated and efficient care, more effective diagnosis, reduction in medical errors, and secure sharing of information10.
One of the studies on EHR, Beacon implementation, done at Mount Sinai hospital in New York was successful. Dr. Adelson Said “The major takeaway from our Beacon implementation is the opportunity to continuously improve and update treatment plans based on published research and guidelines for all practitioners to follow. Ultimately, it allows us to provide higher quality, more comprehensive care to individuals by identifying the most appropriate treatment course while minimizing side effects.” 11
Quality of care has become an important issue with rising health care costs over past decade. Checklist method of WHO can reduce surgical complications and morbidity and help improving quality care. Effective use of COPE and EHR can overcome challenges in measurement of quality of care. Although costs of CPOE and EHR are substantial in terms of technology, organizational process analysis, and system implementation, they can yield many significant benefits and provide important platform for future changes in healthcare quality and patient safety.
1) Landrigan, Temporal Trends in Rates of Patient Harm Resulting from Medical Care, the new England journal of medicine. 2) Kohn LT, Corrigan JM, Donaldson MS, eds. To err is human: building a safer Health system. Washington, DC: National Academies Press, 1999. 3)http://www.ahrq.gov/qual/nhqr08/Chap6.htm
6) http://www.nap.edu/openbook.php?record_id=6418&page=19 7) Debas HT, Gosselin R, McCord C, Thind A. Surgery. In: Jamison DT, Breman JG, Measham AR, et al., eds. Disease control priorities in developing countries. 2nd ed. Disease Control Priorities Project. Washington, DC: International Bank for Reconstruction and Development/World Bank, 2006:1245-60. 8) http://www.nejm.org/doi/full/10.1056/NEJMsa0810119#t=article 9) http://www.leapfroggroup.org/media/file/Leapfrog-AHA_FAH_CPOE_Report.pdf 10) http://www.healthit.gov/providers-professionals/faqs/what-are-advantages-electronic-health-records 11) http://www.equities.com/news/headline-story?dt=2012-12-03&val=782522&cat=hcare
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