Stories about: health care quality

Are tweets a good measure of patient experience and health care quality?

Twitter speech bubblesWhen it comes to gauging quality, we often turn to Twitter, Yelp, Angie’s List and other networks for instant feedback on pretty much any company, contractor or store we do business with.

In contrast, hospitals often rely on tools like the Hospital Consumer Assessment of Healthcare Providers and System (HCAHPS) survey, which gives voice to patients and their concerns about the care they receive. But a new study published in the journal BMJ Quality & Safety suggests social media have something to add to that.

Notes_title_for_overlay“The main problems with measuring patient experience by survey are the small numbers of people who respond to surveys and the lag time,” says Jared Hawkins, MMSc, PhD, of Boston Children’s Hospital’s Computational Health Informatics Program (CHIP). “It can take up to two years before survey data are released to the public. Given that social media data are close to real time, we wanted to see if we could capture this discussion and if the content is useful.”

Hawkins, with Boston Children’s chief innovation officer, John Brownstein, PhD, and their colleagues collected more than 400,000 public tweets directed at the Twitter handles of nearly 2,400 U.S. hospitals between 2012 and 2013. Using machine learning, natural language processing and manual curation, they tagged 34,735 patient experience tweets directed at 1,726 hospital-owned Twitter accounts.

Read Full Story | Leave a Comment

‘Handoff’ tool cuts harmful medical errors 30 percent

Patient handoff I-PASSIt’s increasingly clear that good health care is as much about communication as about using the best medical or surgical techniques. That’s especially true during the “handoff”—the transfer of a patient’s care from provider to provider during hospital shift changes. It’s a time when information is more likely to fall through the cracks or get distorted.

Now there’s solid proof that focusing on communications counts. Last week, The New England Journal of Medicine (NEJM) published a paper showing that implementing a set of handoff procedures and training tools led to a 30 percent drop in injuries from medical errors across the nine participating sites.

Read Full Story | 1 Comment | Leave a Comment

How will health insurance exchanges affect doctors and hospitals?

Healthcare.gov button: Apply now for health coverageThe Affordable Care Act (ACA)’s health insurance exchanges opened for business on Oct. 1, and, despite website glitches and non-stop political fighting, citizens across the U.S. can now comparison shop and pick an insurance plan. Time will tell how well the exchanges will work out for consumers, employers and insurers—as well as what effect they will have on pediatricians and hospitals.

According to Wendy Warring, senior vice president, network development and strategic partnerships at Boston Children’s Hospital, the exchanges may force medical professionals to face changes in patient volume, adjustments in reimbursement rates and shifts in how employers provide benefits to insurers. Right now, she says, “people are very confused about public exchanges versus state exchanges versus private exchanges,” and opinions vary on what impact these changes will have on medical professionals.

Read Full Story | 2 Comments | Leave a Comment

In the ICU, nurse experience and education can mean life or death

Morning rounds on the pediatric cardiac ICU.
Morning rounds on the pediatric cardiac intensive care unit.

Registered nurses (RNs) remain the largest group of health care providers and typically account for the greatest share of most U.S. hospitals’ operating budgets, about 60 percent. In adult hospitals, research has shown a consistently positive effect of increasing percentages of nurses with baccalaureate educations, and linked increased RN staffing and healthy work environments with improved patient outcomes.

However, this assessment has not been conducted in children’s hospitals—until now.

In a study in the Journal of Nursing Administration, nursing leaders from 38 free-standing children’s hospitals explored which nursing and organizational characteristics influence mortality for children undergoing congenital heart surgery.

The study, involving 20,407 pediatric patients and 3,413 pediatric critical care nurses, was led by Patricia Hickey, PhD, MBA, RN, from the Heart Center at Boston Children’s Hospital.

In pediatrics, congenital heart disease is the most common birth defect requiring surgical intervention for survival. Due to their critical care needs, these patients consume a disproportionate share of U.S. hospital resources.

Read Full Story | 1 Comment | Leave a Comment

A closer look at readmission rates for pediatric hospitals is needed

One-size-fits-all metrics dont appear to fit children's hospitals.
One-size-fits-all metrics don't appear to fit children's hospitals.
Government agencies in charge of determining what constitutes efficient, quality health care have taken to looking at hospital readmission rates. On the surface, this makes perfect sense: If patients are continually being readmitted to a hospital, that hospital must not be doing enough to treat patients appropriately on the first go-round. But new research indicates that relying too heavily on readmissions as an efficiency metric may wrongly put some health care institutions—particularly pediatric hospitals—at a disadvantage.

At the American Academy of Pediatrics (AAP) meeting this week, a team led by James Gay, MD, medical director of Utilization and Case Management at Monroe Carell Jr. Children’s Hospital at Vanderbilt, presented research involving more than 1 million patients cared for at children’s hospitals across the country. The team, which also included Boston Children’s Mark Neuman, MD, MPH, posed this question: If hospital ratings are going to be tied so strongly to readmission rates, shouldn’t that rating system recognize the difference between potentially preventable readmissions (PPRs) and those that are unavoidable?

Currently, some state Medicaid programs use software such as 3M PPR, developed for this exact purpose. Like the basic idea that inspired it, the 3M PPR system works well on principle. However, according to Gay and colleagues, it doesn’t capture all the nuances of what makes a readmission preventable or not.

Read Full Story | Leave a Comment

It’s the system, not the parts, says Gawande

Gawande-InnovationSummit0889-K CohenWrapping up the National Pediatric Innovation Summit + Awards on Sept. 27, emcee Bruce Zetter, PhD, who runs a lab in Boston Children’s Vascular Biology program, remarked, “I thought I was going to learn about technology. What I learned about was communication.”

Surgeon, writer and public health researcher Atul Gawande, MD, MPH, laid bare this often overlooked element of medicine in his closing keynote. He eloquently made the point that communication—and more specifically systems—is where innovation is most needed and where it can have the most impact.

“We have emerged from the century of the molecule to the century of the system,” Gawande said.

Right now, these systems are broken, seemingly everywhere. Gawande recounted the sad tale of Duane Smith, a patient who survived a severe car crash that ruptured his spleen, only to lose his fingers, toes, nose and job from an ordinary strep infection.

Read Full Story | Leave a Comment

Consistency and cost: Why reducing variability in health care matters

Many doctors still chafe at practicing "cookbook medicine." (Tim Sackton/Flickr)
The argument that 'I do not practice cookbook medicine' still resonates with many practitioners. (Tim Sackton/Flickr)
Mark Neuman, MD, MPH, practices emergency medicine at Boston Children’s Hospital and is director of Fellow Research and Research Education. Vincent Chiang, MD, chief of Children’s Inpatient Services (CHIPS), contributed to this post, adapted from their recent commentary in Pediatrics.

It’s no secret that the U.S. health care system is in the midst of a financial crisis. As a nation, we spend nearly 18 percent of our Gross Domestic Product on health care, and health care costs remain the largest contributor to the national debt. In 2011 alone, the cost of maintaining the nation’s 5,700 hospitals exceeded $770 billion.

If ever there was a time for a societal mandate to reduce health care costs, that time is now.

It’s widely accepted that one of the first steps to reigning in runaway health care costs is reducing variability in the manner in which care is delivered. Well-defined and well-disseminated best practice guidelines can improve the reproducibility and standardization of care. In time, these guidelines may reduce costly and unnecessary tests and hospitalizations, while providing a platform on which to measure and enhance quality. More consistency may also allow providers to be more efficient with their time, space and personnel.

If it’s so costly, why is health care variability so abundant?

Read Full Story | Leave a Comment

Scaling up quality improvement: How do we motivate providers?

Engaging clinicians in change will require a cultural shift. (David Oliva/Wikimedia Commons)
Engaging clinicians in change will require a cultural shift. (David Oliva/Wikimedia Commons)
Alyssa Bianca Velasco, ScB, is a clinical data specialist for the Standardized Clinical Assessment and Management Plans (SCAMPs) program at Boston Children’s Hospital.

Reducing health care costs doesn’t have to involve making sacrifices in patient safety or quality of care or holding clinicians to rigid guidelines. Over the past several years, Boston Children’s Hospital has rolled out a methodology known as Standardized Clinical Assessment and Management Plans (SCAMPs). Described in the May issue of Health Affairs, SCAMPs are based on the idea that clinicians should be able to diverge from established medical best practices, provided they document the reasons and track the results—in essence making continual data-driven modifications to practice.

The success of SCAMPs in reducing practice variability and costs and improving outcomes at Boston Children’s has led other institutions, one by one, to adopt them. In the next phase, we plan to expand SCAMPs much more broadly, creating a network of hospitals that will pool pertinent clinical data into a centralized non-profit institution, the Institute for Relevant Clinical Data Analytics (IRCDA).

I am part of a team that is providing training, analytics and IT support to help make that large-scale implementation happen.

Read Full Story | Leave a Comment

Reducing unnecessary care: The SCAMPs manifesto

Can we reduce health care costs without rationing? (Image: Fibonacci Blue via Flickr)

We all know the problem: The cost of health care needs to come down. About five years ago, pediatric cardiologists at Children’s Hospital Boston realized it was critical to practice more cost-effectively. “Most of the money that is going to be removed from the federal budget to reduce budgetary deficits is going to come from health care in one fashion or another,” cardiologist-in-chief James Lock told an audience of senior Children’s physicians last month. “There’s no question we were under a tremendous amount of pressure.”

Seeking to eliminate unnecessary care and testing, Lock’s team first turned to clinical practice guidelines, or CPGs, a tool meant to standardize “best practices.” But it soon became clear that CPGs were ineffective, giving no insight into how to improve care or how to deal with unexpected findings. Even worse, over time, many mandated CPGs have been shown to be wrong by subsequent data.

Read Full Story | Leave a Comment