HIMSS launches Quality 101 website

With quality and quality reporting as an integral component of electronic health record incentives for Meaningful Use, HIMSS introduces an online resource – Quality 101 – designed as a primer on the basics and metrics of quality measurement and improvement.  

The HIMSS Patient Safety & Quality Outcomes Committee developed this tool as a portal into the world of quality, quality measurement and improvement. Introduced in phases each quarter, Phase 1 is a ‘primer’ to quality measures with Phase 2 focused on the Plan-D-Study-Act (PDSA) cycle approach to quality improvement and related quality components. 

“Quality measurement and improvement activities have, until recently, been running on separate tracks and parallel tracks with the adoption of healthcare information technology.   With the passage of ARRA and the meaningful use requirements for incentive payment from CMS, we have the de facto merging of these two activities,” said Lou Diamond, M.B.Ch.B., F.A.C.P., F.C.P. (S.A.) Chair, HIMSS Patient Safety and Quality Outcomes Committee.  Dr. Diamond is also Vice President and Medical Director, Healthcare and Scientific, Thomson Reuters. “The Quality 101 website will be attempting to bridge these two parallel worlds, by providing basic information and updates focused on quality measurement and improvement.” 

Visitors to the Quality 101 website will find the following information:

·         Quality - The Basics

·         Quality - Key Industry Players

·         Quality & Meaningful Use

·         Quality - Public Reporting

·         Quality/Cost Relationship

·         Quality – Clinical Decision Support

·         Quality - Resources

Ascent leads industry commitment to quality healthcare as a first-mover on GLN Readiness

As hospitals and providers work to adopt GS1 global supply chain standards into their operations, Ascent, a leader in delivering healthcare resource sustainability, is now ready to work with customers using Global Location Numbers (GLNs). These are standardized identification numbers that give medical locations unique numbers, and will improve the safety and efficiency of healthcare with more effective traceability and improved order, invoice and inventory management capabilities. As the leading re-manufacturer of single use devices (SUDs) and one of the first suppliers to announce GS1 readiness – well before 2010 GLN Sunrise date of December 31 – Ascent demonstrates its leadership and commitment to improving and evolving the healthcare industry.

With this announcement, Ascent joins a handful of leading health providers such as The Mayo Clinic, Banner Health and Geisinger as first-adopters of GLNs and GS1 standards. The GS1 system is the most widely used supply chain standards system in the world, and is implemented globally across industries to improve the efficiency and visibility of supply and demand chains. 

In addition to GLNs, Ascent is also working toward the adoption of product identification numbers known as Global Trade Item Numbers (GTINs) by the 2012 GTIN Sunrise date.  Overall, the adoption of GLNs, GTINs and other GS1 standards will improve the safety and efficiency of healthcare, with more effective traceability and reduced errors through verification.  The standards will also reduce waste and cost within the entire supply chain, ensuring that the right product gets to the right place at the right time. Specifically, synchronized product and location standards will provide increased order and invoice efficiencies, as well as improved inventory management capabilities. Finally, there will be regulatory benefits from medical device identification and efficient traceability.  

NEHI releases brief on comparative effectiveness research                  

The New England Healthcare Institute (NEHI) released an issue brief, “From Evidence to Practice: Making CER Findings Work for Providers and Patients,’’ which details the hurdles and policy choices to effective dissemination of CER findings. Successful dissemination of the new evidence resulting from CER studies is essential if CER is to achieve its desired objectives of improving healthcare outcomes and reducing healthcare spending.

The brief outlines a number of major factors found by NEHI research that could influence the creation of a coherent and effective CER dissemination strategy, including: Existing and anticipated hurdles to CER dissemination; New trends in healthcare improvement that are potential drivers for CER dissemination; and Policy choices for optimizing CER dissemination

The brief sets the stage for a comprehensive report from NEHI later this year that will make specific recommendations for the creation of coherent and effective CER dissemination strategies.

Finding suggests new aim for Alzheimer’s drugs

In a year when news about Alzheimer’s disease seems to whipsaw between encouraging and disheartening, a new discovery by an 84-year-old scientist has illuminated a new direction. The scientist, Paul Greengard, who was awarded a Nobel Prize in 2000 for his work on signaling in brain cells, still works in his Rockefeller University laboratory in New York City seven days a week.

He got interested in Alzheimer’s about 25 years ago when his wife’s father developed it, and his research is now supported by a philanthropic foundation that was started solely to allow him to study the disease. It was mostly these funds and federal government grants that allowed him to find a new protein that is needed to make beta amyloid, which makes up the telltale plaque that builds up in the brains of people with Alzheimer’s.

“This really is a new approach,” said Dr. Paul Aisen, of the University of California, San Diego. “The work is very strong, and it is very convincing.” Dr. Aisen directs a program financed by the National Institute on Aging to conduct clinical trials of treatments for Alzheimer’s disease. Over the past few years, research on Alzheimer’s has exploded. Now, Dr. Aisen said, about 200 papers on the subject are published each week. There are new scans and other tests, like spinal taps, to find signs of the disease early, enabling researchers to think of testing drugs before patients’ brains are so ravaged. And companies are testing about 100 experimental drugs that, they hope, will fundamentally alter the course of Alzheimer’s disease.

Most of the new drugs focus on an enzyme, gamma secretase, that snips a big protein to produce beta amyloid. The problem in Alzheimer’s is thought to be an overproduction of beta amyloid — the protein is made in healthy brains but, it is thought, in smaller quantities. Its normal role is not certain, but researchers recently found that beta amyloid can kill microbes, indicating that it might help fight infections.

But gamma secretase has crucial roles in the body in addition to making beta amyloid. It removes stubs of proteins left behind on the surface of nerve cells and is needed to make other proteins, so completely blocking it would be problematic. Many scientists think that was what went wrong with the Eli Lilly drug, which, researchers say, took a sledgehammer to gamma secretase, stopping all of its functions. Other companies say their experimental drugs are more subtle and targeted, but they may still affect the enzyme’s other targets.

Dr. Greengard found, though, that before gamma secretase can even get started, the protein he discovered, which he calls gamma secretase activating protein, must tell the enzyme to make beta amyloid. And since that newly discovered protein is used by the enzyme only for beta amyloid production, blocking it has no effect on the other gamma secretase activities.

It turns out that the cancer drug Gleevec, already on the market to treat some types of leukemia and a rare cancer of the digestive system, blocks that newly found protein. As a consequence, it blocks production of beta amyloid. But Gleevec cannot be used to treat Alzheimer’s because it is pumped out of the brain as fast as it comes in. Nonetheless, researchers say, it should be possible to find Gleevec-like drugs that stay in the brain.

The system he discovered — the gamma secretase activating protein — made sense, Dr. Greengard said. “Gamma secretase belongs to a family of proteins called proteases,” he explained. Proteases chop proteins into smaller molecules. But often proteases are not very specific. They can attack many different proteins. “Obviously, you can’t have that kind of promiscuity in a cell,” Dr. Greengard said. There has to be some sort of control over which proteins are cleaved, and when.

Study recommends disclosure of medical mistakes that affect multiple patients

Healthcare organizations should disclose medical mistakes that affect multiple patients even if patients were not harmed by the event, according to an AHRQ-funded research paper published in the September 2 issue of the New England Journal of Medicine. Medical mistakes that affect multiple patients, known as large-scale adverse events (LSAEs) to researchers, are incidents or series of related incidents that harm or could potentially harm multiple patients. These events, which can include incompletely sterilized surgical equipment, poor laboratory quality control and equipment malfunctions, are often identified after care has been provided and can affect thousands of patients.

According to researchers from the University of Washington, Seattle, disclosure policies for adverse events that affect individual patients are becoming more common among healthcare organizations but often fail to address how to disclose LSAEs that could have affected many patients.

Researchers weighed ethical considerations of whether to disclose such events. For instance, is disclosure ethical if patients were unlikely to have been physically harmed by the event but could be harmed psychologically by the disclosure? The authors reviewed instances in which healthcare institutions disclosed an LSAE and analyzed the method of disclosure and existing disclosure policies.

They concluded that, in most cases, these events should be disclosed and offered these recommendations:

Develop an institutional policy. Organizations should have a clear set of procedures for managing the disclosure process, notifying patients and the public, coordinating follow-up diagnostic testing and treatment and responding to regulatory bodies.

Plan for disclosures. Disclosures should be made proactively, unless a strong, ethically justifiable argument can be made not to do so. The method of disclosure may depend on the event, but patients should be informed personally and all at the same time.

Communicate with the public. Organizations should assume that media coverage of a large-scale adverse event is inevitable. To build public trust, media responses should demonstrate the organization's commitment to honesty and transparency.

HHS awards $17 million for patient-centered outcomes research

HHS Secretary Kathleen Sebelius announced three sets of grants and cooperative agreements totaling nearly $17 million for patient-centered outcomes research (PCOR), or research that compares treatments and strategies to improve health outcomes for patients.

The three-year funds, made available under the American Recovery and Reinvestment Act of 2009 through the Health Resources and Services Administration (HRSA), will establish a network of PCOR centers, enable PCOR in pediatric emergency medicine, and support building capacity for community-based providers to engage in this type of research.

Five cooperative agreement awards will go to organizations in four states to create the Community Health Applied Research Network (CHARN) to demonstrate that safety net providers and academic institutions can partner together to create an effective infrastructure that supports patient-centered outcomes research. This network in particular will provide an opportunity to evaluate patient-centered outcomes research among diverse populations and patient subgroups that are not always adequately represented in similar studies.

The CHARN consists of a Central Data Management Coordinating Center, based at the Kaiser Foundation Hospitals’ Center for Health Research in Portland, OR, and four networks selected as research “nodes” in California, Illinois, Massachusetts and Oregon. The nodes are geographically dispersed consortia of safety net providers in 17 states. Three of the four research nodes will focus on patient-centered outcomes research related to the delivery of primary care, while the fourth (in Boston), will focus more specifically on research that is relevant to the care and treatment of individuals with HIV/AIDS.

Another grant totaling $3.5 million will be awarded to Columbia University to support patient-centered outcomes research within the Pediatric Emergency Care Applied Research Network (PECARN). The funds will help boost data capacity, conduct studies and disseminate information on research findings involving pediatric emergency care.

Premier issues letters in response to the electronic health record incentives for Multi-Campus Hospitals Act of 2010 

Premier Inc, in letters to the Senate and the house, commented about their concerns on  the July 2nd, 2010 final regulations for Meaningful Use (MU) of health information technology (HIT). CMS chose to provide a single base payment to co-located and multi-campus hospitals. Because hospitals incur separate costs for each inpatient facility, this arbitrary approach unfairly handicaps co-located or multi-campus hospitals, and will significantly cut into payments these facilities need to successfully deploy electronic health records. Moreover, since HIT is a cornerstone of new ACO models under consideration, limiting base payments in this way could have the unintended consequence of slowing ACO implementation.

“Premier is committed to facilitating rapid implementation of electronic health record (EHR) technology by all Premier alliance members. We believe these technologies will greatly help improve quality and efficiency and lead to improvements in community health. However, in the final meaningful use (MU) regulation, the Centers for Medicare & Medicaid Services (CMS) created an arbitrary and inequitable distinction between identical hospital systems based solely on whether a system has multiple inpatient facilities operating under a single Medicare provider number. Providing MU incentive payments to only one hospital in a multi-hospital system would not accurately account for the implementation and training costs of EHRs across different institutions; nor would it accurately reflect differences in clinical services provided at different sites. This payment inequity will slow down EHR adoption rather than expedite it as envisioned by the HITECH Act.

Your bill will ensure that payments would be available to all hospitals in a multi-campus system, and that these hospitals could choose the calculation that would best meet the needs of their institutions and communities, either through additional base payments or additional per discharge amounts.”

Tygacil (tigecycline): Label change - increased mortality risk

FDA reminded healthcare professionals of an increased mortality risk associated with the use of the intravenous antibacterial Tygacil (tigecycline) compared to that of other drugs used to treat a variety of serious infections. The increased risk was seen most clearly in patients treated for hospital-acquired pneumonia, especially ventilator-associated pneumonia, but was also seen in patients with complicated skin and skin structure infections, complicated intra-abdominal infections and diabetic foot infections. FDA has updated sections of the Tygacil drug label to include information regarding increased mortality risk of Tygacil.

Tygacil is approved by FDA for the treatment of complicated skin and skin structure infections, complicated intra-abdominal infections, and community acquired pneumonia. Tygacil is not approved for the treatment of hospital-acquired pneumonia (including ventilator-associated pneumonia) or diabetic foot infection. The increased risk was determined using a pooled analysis of clinical trials.