Just an occasional post when I come upon a few interesting reports and resources that are worth a download or browse. This week we have a few.
First we have:
Quality down for non-QoF care
27 Jul 2009
The Quality and Outcomes Framework has led to a reduction in the quality of care for activities not included in the QoF and had a negative impact on continuity of care, according to a new study.
Researchers from the National Primary Care Research and Development Centre in Manchester looked at the quality of care in 42 GP practices in 1998 and 2003, before the QoF was launched, and in 2005 and 2007 following implementation of the framework.
The analysis examined care of patients with asthma, diabetes or coronary heart disease using data extracted from medical records and data from patients’ questionnaires on access to care, continuity of care and interpersonal aspects of care.
The results, published in the New England Journal of Medicine, showed that there were significant improvements in care provided for the three major diseases between 1998 and 2007 with the rate of improvement accelerating for asthma and diabetes after the introduction of the QoF.
However the rate of improvement slowed after 2005 for all three conditions and the quality of aspects of care not associated with an incentive in the QoF declined for patients with asthma or heart disease. Continuity of care also immediately declined after the introduction of the pay-for-performance scheme and then continued at that reduced level.
Much more here :
http://www.ehiprimarycare.com/news/5062/quality_down_for_non-qof_care
The full paper can be found here:
http://content.nejm.org/cgi/reprint/361/4/368.pdf
This is critical stuff that needs to be carefully reviewed and considered in the design of any ‘pay for performance’ incentive program.
The last paragraph of the discussion says it all.
“In conclusion, between 1998 and 2007, there were significant improvements in measurable aspects of clinical performance with respect to the care provided for three major chronic diseases. The initial acceleration in the underlying rate of quality improvement after the introduction of pay for performance was not sustained. If the aim of pay for performance is to give providers incentives to attain targets, the scheme achieved that aim. There may have been unintended consequences, including reductions in the quality of some aspects of care not linked to incentives and in the continuity of care.”
One line summary – “Provide incentives for the behaviour you want! It will work, but be careful what you leave out!”
Second we have:
Some 45,000 docs eligible for EHR subsidies: study
Posted: July 27, 2009 - 5:59 am EDT
Researchers at the George Washington University School of Public Health and Health Services estimate that as many as 45,000 physicians are eligible to receive up to $63,750 in Medicaid subsidy payments for the purchase and use of electronic health-record systems under the American Recovery and Reinvestment Act of 2009. If all of the Medicaid-eligible physicians receive the maximum payments, the researchers conclude, taxpayers will invest more than $2.8 billion in the EHR subsidy program.
More here:
http://www.modernhealthcare.com/article/20090727/MODERNPHYSICIAN/307269983
The report is found here:
This is certainly a serious level of investment in getting EHRs in place.
Third we have:
Study Finds Electronic Health Records Not Ready for Genetic Information
- Jul 24, 2009
Current electronic health records (EHRs) have a long way to go to meet the challenges of genetic/genomic medicine, reports a study in the July issue of Genetics in Medicine, the official peer-reviewed journal of The American College of Medical Genetics.
Although EHR systems have the potential to help integrate genetic information into everyday health care, they'll need new structure, standardization, and functionality to meet this goal, according to the new study led by Dr. Maren Scheuner of RAND Corp., Santa Monica, Calif. The researchers interviewed medical geneticists, genetic counselors, primary care doctors, and EHR vendors and specialists regarding the present and future role of EHRs in storing and using genetic information.
State-of-the-art EHRs lack the features needed even to record genetic information in a systematic way--much less use it in medical decision making, the responses indicated. While current EHR systems provide space for information on the patient's family history, there were limitations on how the information could be entered and used. For example, few systems were able to create or store a pedigree charting the inheritance of genetic conditions within families. EHRs provided little clinical decision support to help doctors assess the risk of genetic diseases or provide treatment alerts based on the family history. Systems also varied in the way they handled the security of genetic test results.
More here:
The abstract for the paper is here:
It is important that these issues be carefully addressed as we move forward.
Fourth we have:
States Look to Electronic Prescribing to Move Toward a More Efficient Health Care System
NGA Center Issue Brief Highlights State Actions to Achieve a Higher Quality Health Care System Contact: Krista Zaharias, 202-624-5367
Office of Communications
Accelerating the Adoption of Electronic Prescribing
WASHINGTON—States are using innovative strategies to address the issue of integrated electronic health records and the electronic exchange of health information, according to a new Issue Brief from the National Governors Association Center for Best Practices (NGA Center).
Accelerating the Adoption of Electronic Prescribing examines electronic prescribing, or e-prescribing—the computer-based electronic generation and transmission of a prescription. E-prescribing improves patient safety and quality of care, increases prescribing accuracy and efficiency and reduces health care costs by making critical information available to health care providers. The use of e-prescribing will grow as states and others provide support for e-prescribing. In recent years, states annually have doubled the number of prescriptions sent electronically. If states stay the course, this rate of adoption will reach at least 50 percent by 2012, according to State Alliance for e-Health Call to Action for NGA.
More here:
The report link is in the text
Good to see the pressure is building in this area.
Fifth we have:
Defense, VA halfway to full EHR interoperability: GAO
By Joseph Conn / HITS staff writer
Posted: July 29, 2009 - 11:00 am EDT
The healthcare organizations of the Defense and Veterans Affairs departments have met three of six objectives toward achieving what they have self-defined as “full interoperability” between their respective electronic health-records systems and “partially achieved planned capabilities” in the other three. However, those and the joint management program overseeing the project still need “additional work” to meet a Sept. 30 deadline, according to the Government Accountability Office.
The congressional watchdog, in a 35-page report, said the DOD/VA Interagency Program Office “is not yet effectively positioned to function as a single point of accountability for the implementation of fully interoperable EHR systems or capabilities between DOD and VA.”
More here:
http://www.modernhealthcare.com/article/20090729/REG/307299987
The link to the report is in the article.
Seems like a little way to go – but this is not an easy issue to address with two complex legacy systems.
Sixth we have
Prevention and Health Promotion Could Save Medicare $1.4 Trillion Over 10 Years
Les Masterson, for HealthLeaders Media, July 30, 2009
Government health promotion and prevention programs for pre-Medicare and Medicare populations could save the country as much as $1.4 trillion over 10 years—and add on average as many as 6 years on Medicare beneficiaries' lives, according to a new Center for Health Research at Healthways report.
Today's report, Potential Medicare Savings Through Prevention & Health Risk Reduction, found that focusing on programs that keep people healthy and reduce health risk factors, and manage chronic conditions—before and during Medicare eligibility—can have long-term cost savings. In fact, though these programs could extend beneficiaries' lives, the researchers found the cost savings associated with keeping people healthier would offset the extra years of life and coverage expenses that the federal government would have to pay for under Medicare.
"In this report, we clearly showed that you can, in fact, reduce risk and this does increase life expectancy, but you can still achieve savings over the course of a lifetime," says Elizabeth Rula, PhD, lead researcher at the CHR.
With baby boomers reaching Medicare age, the Medicare population is expected to jump from 45 million to nearly 80 million by 2030. Couple that fact with the healthcare reform debate in Washington and one can see why healthcare thought leaders and policymakers are searching for programs and savings to bend the healthcare cost curve.
Much more here:
http://healthplans.hcpro.com/content.cfm?content_id=236758&topic=WS_HLM2_HEP
Link to report in text.
Ms Roxon needs to read this one closely!
Lastly we have:
Most states monitoring diseases electronically: CDC
By Jean DerGurahian / HITS staff writer
Posted: July 30, 2009 - 11:00 am EDT
Most states have operational electronic disease-surveillance systems and are using a combination of systems to conduct disease surveillance and report public health information to the federal government, according to a status report by the Centers for Disease Control and Prevention.
In its weekly morbidity and mortality report, the CDC released findings from a 2007 survey it conducted to assess the progress states were making in developing electronic surveillance systems. Most states are using a mix of vendor information technology products, state-developed systems and the National Electronic Disease Surveillance System supported by the CDC to monitor diseases, the CDC said in its report. “State electronic disease surveillance systems varied widely and were in various stages of implementation,” according to the report.
More here (registration required):
http://www.modernhealthcare.com/article/20090730/REG/307309989
The report is in the text.
I wonder how close we would be to the status found here?
Enough goodies for one week!
Enjoy!
David.
1 comment:
I would guess that the 2nd and 3rd items above should refer to EMRs rather than EHRs. See the definition of these terms in last week's blogs.
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