Archive for January 2017

Do Clinicians Understand Quality Metric Data?

The number and complexity of quality metrics within healthcare continues to expand, many of which are used to compare performance between hospitals, systems, and/or clinicians. To make these comparisons fair, many quality reporting agencies attempt to “risk stratify” these metrics, so as not to penalize those caring for higher complexity patients. Although laudable, these attempts also increase the complexity of the data and may reduce the ability of clinicians to understand and analyze quality performance. A recent article in the Journal of Hospital Medicine explores clinicians’ understanding of quality metrics using central line associated bloodstream infections (CLABSIs) as an example. The investigators used a unique Twitter-based survey to explore clinicians’ interpretation of basic concepts in public-reported CLABSI rates and ratios. I recently caught up with the lead author, Dr. Sushant Govindan, to better understand his team’s research and its implications for quality reporting. Dr. Govindan is a Pulmonary-Critical Care fellow…

The Nursing Home Get Out of Jail Card (“We Don’t Want Our Patient Back”). It’s Now Adios.

The Centers for Medicare & Medicaid Services (CMS) has not updated its rules ("conditions for participation") for nursing homes in twenty-five years. Late last year they finally did. Many of the changes will have an impact on the daily lives of NH residents but are far removed from hospital medicine.  Think a resident's ability to pick their own roommate and have all hours visitors.  However, there are a few changes that intersect with HM, and a notable one will affect how you respond to a frequently encountered roadblock long-term care facilities sometimes throw our way. First, though, some of the changes CMS finalized.  With SHM members now moving into the post-acute and LTC realm, several have real relevance (I only cite a sliver of them): (more…)

Fake News! Get Your Fake News Here!

One of the top stories of 2016 is fake news. Chances are, in 2017, we will continue to fall for these fairy tales. When people think Obamacare and the Affordable Care Act are two completely different entities, we know facts can dissipate quickly. Why are we duped so easily? These stories fit into a narrative we want to believe in, reinforcing our often insular views, where the echo chamber reverberates at high frequency. We digest only headlines and forward those along, not having time to fully read the stories. Lack of faith in the "media" causes us to trust any headline from any source over the mainstream media. Facebook is recognizing the large role it plays in dissemination of fake stories to the extent that it plans to roll out a new filter in Germany to begin to fight this epidemic. Here's how you and others can combat fake news…

The Inmates Are Running the Asylum

OK; that might be a bit of an exaggeration. But if you left your clinical shift asking why you feel so depleted and frustrated and why you had that negative interaction with that patient, you should do yourself a favor and read the recent review in the Journal of Hospital Medicine entitled "When Personality Is the Problem: Managing Patients with Difficult Personalities on the Acute Care Unit". In this article, it notes that about 4-15% of the population is affected by at least one personality disorder and that this prevalence is thought to be much higher in those seeking healthcare services – perhaps as high as 25% of the population. This is thought to be due to in part to lifestyle factors, such as drinking and drug use, as well as the fact that individuals who possess these dysfunctional personality structures may have difficulty accessing and utilizing care adequately. These…

Online Ratings For Hospital CEO, CFO’s, etc.

This week's NEJM features an article on hospital-sponsored online rating sites for docs.  The author, Vivian S. Lee, M.D., Ph.D., MBA, a prominent health services researcher discusses the adoption and success of her program at the University of Utah and how the system uses a portal open to patients to evaluate staff. In the piece, she covers familiar ground. Early renunciation and eventual acceptance by faculty in a manner you can predict: initial fears of reputation and prestige loss give way to a stable system allowing docs to obtain feedback in real time to improve their game.  It is not all wine and roses in her telling, but like all things, the apocalypse never materializes, and the once unthinkable becomes business as usual. Docs adjust.  Life moves on. Also in her viewpoint, she cites a recent study of interest that continues to get a lot of attention whenever inquiring minds consider provider ratings.…
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