Archive for September 2007

Bob’s Books (and Articles and Websites)

Here are a few of my books:Understanding Patient Safety (McGraw-Hill’s Lange Series, 2008): A lively, up-to-date primer on patient safety, full of case vignettes, tools, and other key resources.Internal Bleeding: The Truth Behind America’s Terrifying Epidemic of Medical Mistakes (“Updated Version”, Rugged Land, 2005): A bestselling book that uses dramatic cases of medical errors to illustrate the key principles of patient safety. Written with Kaveh Shojania.Hospital Medicine (Lippincott Williams & Wilkins, 2005): A medical textbook for those who care for hospitalized patients. Co-edited by Lee Goldman and Harry Hollander.Making Health Care Safer: A Critical Analysis of Patient Safety Practices. Agency for Healthcare Research and Quality, AHRQ Publication No. 01-EO58: The first review of the evidence behind safety practices, it catalyzed future evidence-based safety initiatives such as the National Quality Forum’s list of "Safe Practices.” My co-editors are Kaveh Shojania, Kathy McDonald, and Brad Duncan.The Fragile Coalition: Science, Politics and AIDS…

P4P is Dead. Long Live P4P!

P4P (pay for performance) is all the rage in healthcare. And why not? In the face of the damning evidence that we "get it right" only about half the time, criticizing linking higher payments to better care seems frankly un-American. And there is accumulating evidence that P4P may work. A study earlier this year by my friend Peter Lindenauer found that P4P led to about a 3 percent improvement in quality measures (compared to public reporting alone) over two years. The Centers for Medicare & Medicaid Services (CMS) surely believes in it, promoting their P4P experiments at every turn. And where CMS goes, private payers usually follow. But P4P is really tricky. As in… How much do you pay for better performance? In most industries, bonuses of less than 5-10% are felt to be all-but-meaningless. But few believe that P4P bonuses will be more than 5%, because... Where does the…

Why a Blog?

It’s not like you don’t have enough to read, or that I don’t have enough to do. So, why do I blog? And why should you read? We are in the early days of a revolution in healthcare. The hospitalist field has grown from an idea – given breath by a handful of hardy pioneers – to a thriving specialty of more than 20,000 doctors: the fastest growing field in the history of American medicine. Hospitals have moved from assumed, reputational quality to a new kind of quality: measured, reported, and sometimes even paid for. Evidence-based medicine is rapidly supplanting eminence-based medicine. Patient safety wasn’t even in the lexicon a decade ago; now it seems to dominate every discussion. Housestaff work hours, nurse-to-patient ratios, the Joint Commission, medication reconciliation, CPOE, EMRs, PHRs.... What an incredibly exciting time to be in the middle of the storm. But it is also disorienting…

Bob’s Favorite Links

Here are a few of the healthcare links I enjoy reading:ABIM Foundation Medical Professionalism Blog An Insider's View on Health CareClinical Cases and Images BlogComarow on QualityDB's Medical RantsEGMN Notes from the RoadGeriPalHappy HospitalistHealth Affairs BlogHealth Beat BlogHealth Care BlogHealthcare IT GuyHealth Care RenewalHealth Care Organizational EthicsKevin, MDNeil Versel's Healthcare IT BlogNotes from Dr. RWRobert Wood Johnson Clinical Scholars PodcastsRunning a HospitalSchwitzer Health News BlogSHM's Clinical BlogSHM's Practice Management BlogWSJ Health Blog