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Update from The Pond. Founded By The Business Roundtable with Support From the Robert Wood Johnson Foundation. Greg Belden, Senior Program Associate gbelden@leapfroggroup.org June 18, 2004. Populating the Pond. Leapfrog represents.. More than 155 large health care purchasers - PowerPoint PPT Presentation
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Update from The Pond
Greg Belden, Senior Program Associate gbelden@leapfroggroup.org
June 18, 2004
Founded By The Business Roundtablewith Support From the Robert Wood Johnson Foundation
Populating the Pond
Leapfrog represents..
More than 155 large health care purchasers
More than 34 million Americans
More than $62 billion in health care expenditures
Leapfrog Members to DateFord Motor CompanyGateway Purchasers for Health General Electric CompanyGeneral Mills, Inc.General Motors CorporationGeorgia Health Care Leadership Council Georgia-Pacific CorporationGlaxoSmithKlineGreater Milwaukee Business Group on Health and the Health Care Network of WisconsinHampton Roads Health CoalitionHannaford Bros. Co.Healthcare21 Business CoalitionHealthPartnersHealthPlus of MichiganThe Health Action Council of Northeast OhioHealth Alliance Plan (HAP)Health Care Payers Coalition of New JerseyHealth LanguageHealth Net Inc.Horizon Blue Cross Blue Shield of New JerseyHoneywell Inc.HCA - Hospital Corporation of America HIP Health Plan of New YorkIndiana Employers Quality Health AllianceInternational Association of Machinists and Aerospace WorkersIBMIDX Systems CorporationInternational Paper CompanyJSA Healthcare Medical GroupJohnson Controls, Inc.Johnson CountyJostensKellogg CompanyThe KNW GroupLG&E Energy CorporationLTV Steel CompanyLand O’ LakesLockheed Martin CorporationLucent TechnologiesM-Care, Inc.MDanywhere Technologies Inc.MVP Health CareMaineHealthMaine Health Management CoalitionMaine Municipal Employees Health TrustMaine State Employee Health CommissionMarriott International, Inc.Massachusetts Healthcare Purchaser GroupMcKesson CorporationThe Mead CorporationMerck & Co., Inc.Meridian Automotive Systems, Inc.Microsoft CorporationMidwest Business Group on HealthMinnesota LifeMinnesota Mining & Manufacturing Company (3M)Misys Hospital SystemsMonsanto CompanyMotorola, Inc.National Education Association
AT&TAetna Inc.Allscripts Healthcare SolutionsAmerican Century Services Corporation American Federation of TeachersAmerican Medical SystemsAmerican Re-Insurance CompanyAmerisourceBergen CorporationArvinMeritor, Inc.AstraZenecaThe Auto Club GroupAventis Pharmaceuticals Inc.Barry-Wehmiller Group, Inc.Bath Iron Works CorporationBecton, Dickinson and Company (BD)Bemis Company, Inc.Bethlehem Steel CorporationBoard of Pensions of the Presbyterian Church (U.S.A.)The Boeing CompanyBrown ShoesBuyers Health Care Action GroupCargill, Inc.Carlson CompaniesCaterpillar Inc.Ceridian CorporationCerner CorporationCharter CommunicationsChicago Business Group on HealthCIGNA CorporationCITIGROUP INC.Cleveland State UniversityColorado Business Group on HealthComericaThe Commonwealth of Massachusetts Group Insurance CommissionCoors Brewing CompanyCummins Inc.DaimlerChrysler CorporationDallas-Fort Worth Business Group on HealthDelta Airlines, Inc.The Department of Employee Trust Funds and State of Wisconsin Group Insurance BoardThe Doe Run CompanyThe Dow Chemical CompanyEastman Kodak CompanyEclipsys Corporation Electronic Data SystemsEli Lilly and CompanyEmpire Blue Cross and Blue ShieldEmployer Health Care Alliance Cooperative (The Alliance)Employers’ Health CoalitionESCO Technologies, Inc.Excellus Inc.Exxon Mobil CorporationFedEx CorporationFidelity InvestmentsFisher Scientific InternationalFlint InkFleet Boston Financial
National Rural Electric Cooperative AssociationNevada Health Care CoalitionNew Jersey State Health Benefits ProgramNew York Business Group on HealthNorth Carolina Business Group o Health, Inc.North Carolina Teachers’ and State Employees’ Comprehensive Major Medical Plan Northwest Airlines, Inc.Olin Corporation, Brass & Winchester DivisionsOxford Health Plans, Inc. Pacific Business Group on HealthPediatrix Medical Group Inc.PepsiCo Pillsbury CompanyPitney Bowes Inc.The Procter & Gamble CompanyPromina Health System, Inc.Quality Systems Inc.Quest DiagnosticsQwest Communications International Inc. Ramsey CountyReliant Energy, IncorporatedRobert Wood Johnson University HospitalRobert Wood Johnson University Hospital at HamiltonRyder System, Inc.Savannah Business GroupSchering-Plough CorporationSiemens CorporationSolutia, Inc.South Central Michigan Health AllianceSouthern California Schools Voluntary Employees Benefits Association Sprint CorporationState of Kansas Division of Personnel ServicesSUPERVALU INC.TCF Financial CorporationTI AutomotiveTRW Inc.Target CorporationTennant CompanyTextron Inc.Trinity Health PlansTri-State Business Group on HealthTufts Health PlanUnion Pacific RailroadUnion Pacific Railroad Employees Health SystemsUnitedHealth Group United Parcel ServiceUniversity of Maine System Verizon CommunicationsWEA TrustWashington Mutual BankWashington State Health Care AuthorityWausau Benefits, Inc.Wells FargoWiseman and Associates Financial Services, LTDXcel EnergyXerox Corporation
The U.S. Office of Personnel Management (OPM); Centers for Medicare and Medicaid Services (CMS); the Department of Defense; and Minnesota Departments of Human Services and Employee Relations also participate as liaison members.
ProvidersNot Seeing Case for
Reengineering
InsurersNot Letting Provider Value Show Through
PurchasersNot Buying Right,
Toxic Payment System
ConsumersNot In the Quality
Game
Why Isn’t Quality Better?
Gridlock in the Health Care System: Everyone Responsible, No One Accountable
New Thinking Needed to “Leapfrog” Gridlock
The Silent Calamity
Needless mortality and morbidity
44,000-98,000 plus deaths each year from medical errors during hospitalizations (IOM, 1999)
7,000 deaths from medication errors alone
$17-29 million in added costs
Number of avoidable deaths in ambulatory care unknown
Preventable Deaths Personalized: The General Motors Example
US Population: 250,000,000
Preventable deaths per year: 98,000
Preventable deaths per 100,000 Americans per year: 39
GM’s covered lives: 1,250,000
GM’s preventable deaths–Per year: 488!–Per day: 1.3!
The Costs of Poor Quality Care
Patients, on average, receive recommended health care only 55 percent of the time (McGlynn et al. 2003)
30 percent of all direct health care outlays are the result of poor care (misuse, underuse, overuse, and waste) (Juran Institute/MBGH 2003)
Employers Fund U. S. Health Care System – The Buck Starts Here
Employers Fund U. S. Health Care System – The Buck Starts Here
How Are Employers Responding to Rising Costs?
8%
17%
20%
35%
51%
21%
36%
37%
47%
28%
35%
32%
30%
34%
12%
26%
15%
13%
5%
8%
Offer a high deductible plan
Implement new deliverysystems and purchasing
models
Move to differenthealthplans
Employ condition/diseasemanagement and healthimprovement programs
Increase employee costsharing
Primary Focus Moderate Interest Minimal Interest No InterestSource: Hewitt Associates, 2002Kaiser/HRET Survey, 2003
Less than 15% of employers think these changes will be “very effective”.
The Leapfrog Group’s Mission
Trigger giant leaps forward in the safety, quality and affordability of health care by:
– Supporting informed health care decisions by those who use and pay for health care
– Promoting high-value health care through incentives and rewards
Leapfrog’s Mission and Vision Aligned with IOM
Pursuit of Comparative Excellence
Measuring both hospital and physician performance across all 6 IOM Health Care Aims
– Timeliness
– Efficiency
– Safety
– Effectiveness
– Equity
– Patient-centeredness
Purchasing Principles
Educate and inform enrollees
Compare at the provider level
Reward superior provider value
– Patient volume (select/deselect/freeze,consumer incentives, consumer decision support)
– Unit price (pay for performance)
– Public recognition
Highlight tangible, evidence-based quality and safety practices (‘Leaps’)
Criteria for Safety Leaps
What’s the Difference? Leap will produce big improvement in safety
Value Self-Evident: Leap can be appreciated by consumers
Feasible Now: Implementation steps are doable
Easily Ascertainable: Purchaser or health plan can see if Leap is in place
Keep the List Short: Leaps can be remembered
Initial Quality and Safety ‘Leap’ Summary
An Rx for Rx
– Computer Physician Order Entry (CPOE)– Up to 8 in 10 serious drug errors prevented
Sick People Need Special Care
– ICU Daytime Staffing with CCM Trained M.D. live or via tele-
monitoring, or risk-adjusted outcomes comparison– 29% mortality reduction (JAMA, 11/02)
The Best of the Best
– Evidence-based Hospital Referral (EHR) or risk-adjusted
outcomes comparison– > 30% mortality reduction for 7 complex treatments
New! Overall Safety (See Appendix)
– Rolled-up score of the remaining 27 of the 30 NQF Safe Practices
(CPOE, IPS and EHR are the other 3 of the 30 NQF Safe Practices)
Annual Gain Projected by Dartmouth: 560,000-907,000 serious medication errors 61,700 deaths 61,700 X 5 disabilities Potential savings $9.7 billion / year
(if fully implemented in U.S. urban hospitals)
What We Stand to Gain from Initial 3 Leaps Alone?
Leap Refinement –Creating More Sophisticated Measures
CPOE: Online evaluation tool developed by First Consulting Group
ICU Staffing: Joint project with JCAHO to develop risk-adjustment methodologies and reporting program; e-ICU (telemedicine) now applicable
Evidence Based Hospital Referral: Seeking additional sources for outcomes reporting
Our Approach to Measure Development & Implementation
Collaborate with measure developers
– CMS, AHA, AHRQ, NCQA, JCAHO, others
Seek consensus on breadth and content of measurement set
Advance measures through NQF for consensus approval
Develop rapid implementation strategy with key partners
Leapfrog Leaps, Today and Tomorrow
Today: Hospitals
CPOE, IPS, EHR, NQF Safe Practices
Tomorrow: Hospitals and Physician Offices
Physician Office Clinical Decision Support (See Appendix)
– Initial development coordinated with HHS, awaiting outcome of HHS-led push toward nationwide EMR implementation
– Minimum standards: E-prescribing, E-lab results management, and E-care reminders
– Already in practice- CMS DOQ-IT, Bridges to Excellence Physician Office Link
Leapfrog’s Position on EMRs
Leapfrog supports the promotion and use of electronic data to protect patient safety and quality and recommends that hospitals implement CPOE systems.
An effective CPOE system rests on a broad array of patient information and an electronic medical record is one of the first steps to achieving this.
How Leapfrog Happens: Leaping in Unison
Health Plans (MD Leadership & Governance)
Purchasers
Consumers
Health Care Delivery System
(hospitals, physicians,
nurses pharmacy...)
Leapfrog’s Regional Roll-Outs
Leapfrog is a national movement using targeted regions (Regional Roll-Outs) to develop best practices, creating early successes and learning from all stakeholders.
*23 Regional Roll-Out areas reach 50% of Americans.
Regions must have: Effective leadership Competitive health
care market High concentration of
Leapfrog lives
*LF Regions in Green w/ exception of NV and NC
First Wave: First Wave: California
Seattle/Everett/ Tacoma
St. Louis
Michigan
East Tennessee
Minnesota
Atlanta
Dallas/Fort Worth
Colorado
Kansas City
Wisconsin
Savannah
Metro NY & Western CT
Rochester NY
Massachusetts
New Jersey
Central Florida
Memphis
Wichita
Second Wave:Second Wave: Maine
Illinois
Hampton Roads, VA
Third Wave:Third Wave:
23 Roll-Out Regions
Northern NV
*Raleigh/Durham/ Chapel Hill, NC
Fourth Wave:Fourth Wave:
*On Hold for 2004
Collecting Hospital Level Data
Hospital survey available via The MEDSTAT Group
Ongoing voluntary Web survey
Outreach to hospitals in 23 Roll-Out areas to date, but nationally available
Survey captures hospitals on the path
Data publicly reported, format based on feedback from consumers and hospitals (survey and results: www.leapfroggroup.org
Leap Applicability to Urban/Rural Hospitals
2001-2003- Leaps Apply to Only Urban Hospitals
Areas where consumers have a choice of hospitals
Do not want to raise public expectation that rural hospitals should prioritize the leaps
2004 and Beyond- Leaps Apply to Urban and Rural
4th Leap (NQF Safe Practices) applies to Rural Hospitals
Rural task force working to apply initial 3 leaps to rural hospitals
Hospitals Are Reporting from All Over the Country
No ParticipationParticipation inRoll-Out RegionsParticipation inNon Roll-Out Regions
NM
WYSD
VT
RI
MT
Progress 2nd Quarter 2004 (cont’d)Hospital Survey Results - Regions
Final Results 1.0 Final Results 2.0
810 hospitals nationwide responded to Leapfrog’s survey
558 of 949 targeted in Regional Roll-Out areas (58.7%)
> 60% participation in 13 of 18 RROs
1,168 hospitals nationwide responded to Leapfrog’s survey
715 of 1,188 targeted in Regional Roll-Out areas (60.2%)
> 60% participation in 17 of 22 RROs
Hospital Survey Results – Regions
CPOEFinal Version 2.0– 5% (34) of the responding hospitals have fully
implemented CPOE - another 17% (118) will implement by 2005
Final Version 1.0– 5% of the responding hospitals had fully
implemented CPOE - another 22% said would implement by 2005
Hospital Survey Results – Regions
IPSFinal Version 2.0– 24% of responding hospitals have fully
implemented IPS
Final Version 1.0– 21% of responding hospitals had fully
implemented IPS - another 15% said would implement by 2004
Hospital Survey Results – Regions (cont.)
EHR % of responding hospitals meeting Leapfrog’s standard
Final Version 1.0
Final Version 2.0
CABG 12% 14%
Coronary angioplasty/PCI
30% 12%
AAA 21% 16%
Pancreatectomy N/A 15%
Esophagectomy 12% 8%
NICU 23% 39%
Consumers as Drivers
“Preventable mistakes” are frequent and serious
Provider differences can be significant
Enrollee Communications Toolkit by FACCT(NEW version available)
Engage Consumers
Heart NEJM 12-12-2002
– Leapfrog toolkit
– KFF survey results
Engage Consumers
Heart
– Leapfrog Toolkit
– NEJM survey results
Mind
– Web Hits
-
20,000
40,000
60,000
80,000
100,000
120,000
140,000
160,000
1st Qtr 2nd Qtr 3rd Qtr 4th Qtr
Subimo
DQ
SQC
HealthGrades
Engage Consumers
Heart
– FACCT Toolkit
– NEJM survey results
Mind
– Web Hits
Wallet
– Co-pays, co-insurance
Number of Hospitals Responding to Leapfrog Survey
Atlanta, GA Dallas, TX CPOE ICU CPOE ICU
Fully Implemented
0 0 0 1
Good Progress
8 0 0 0
Tier 1 Criteria
Good early stage progress
2 3 1 2
Willing to report
14 16 14 10 Tier 2 Criteria
Did not submit information
7 12 0 2
DRAFT
The Leap Over the Gridlock Has Begun
Rapid growth in purchasers signing on to Leapfrog’s approach
Rapid growth in hospitals disclosing status to their communities
Active health plan support 80% of Americans have access to information for at
least one hospital in their community Massive education of consumers through purchasers Market reinforcement beginning through different
channels
Inform & Educate
Enrollees
Compare Providers
Rewarding & Creating
Incentives for Quality & Efficiency
Member Support & Activation
Improved Value (Quality &
Efficiency)
Multipliers: Health Plan Products
Federal & state purchasers
Other distribution channels &
partners
Market Reinforcement: “The Multiplier Effect”
Where We are Beginning to Make Progress
Transparency
Movement towards standardization of measures
– The National Quality Forum
– Medicare Modernization Act 2003: IOM to “evaluate
leading health care performance measures”
Education
Creation of consumer demand for good quality care
– 80% of Leapfrog members communicate to their
employees about medical errors and 70% about
Leapfrog
“Putting the Money Where Our Mouth Is- Working Markets Must Reward Quality”
Current reimbursement system does little to encourage quality improvement
– 80% of Leapfrog members publicly recognize providers but only 30% are working to reward providers
Optimal Incentive and Reward systems
– Pay-for-Performance/Direct Financial Reward (DFR) models
– Bonus payments/Financial awards
– Volume/Market-share Shift/Direct-to-Consumer (DTC) models
– Tiering, Payment differentials
Lily Pads: Opportunities to Shape the Movement
BOARD & MANAGEMENT
COMMITTEE
REGIONAL LEADERS
ENROLLEECOMMUNICATIONSLEAPS & MEASURES
BENEFITS CONSULTANTS
INCENTIVES & REWARDSCLINICIANHEALTH PLANS
Paying for Performance (DFR)
Blue Cross Blue Shield of Michigan
Blue Cross of California
Bridges to Excellence
Excellus
Pay for Performance - Integrated Healthcare Association (IHA)
Medi-Cal/Healthy Families - Integrated Healthcare Association (IHA)
Massachusetts Health Quality Partners
Paying for Performance (DFR)
Bridges to Excellence
Physician Office Link
– Physicians can earn up to $50 per sponsored patient
– Must pass NCQA office practice performance assessment program
http://www.ncqa.org/pol/
IHA
Paying for Performance
– Common measures
– Clinical quality (40 percent)
– Patient experience (40 percent)
– Investment in information technology (20 percent)
– Each plan comes up with own reward methodology
Paying for Performance (DFR)
Other Initiatives
Empire Blue Cross, IBM, PepsiCo, Verizon, and Xerox (NY)
– Hospitals: 4% bonus if meet Leapfrog’s CPOE and ICU standards
Group Insurance Commission (MA)
– Health plans: $25-50K bonus if plans increase admissions to Leapfrog-compliant hospitals
Anthem Blue Cross Blue Shield (NH)
– Physicians: $20 per enrollee for group practices that finish in top quartile for quality scores
Market-share/Volume Shift (DTC)
Minimum Maximum
Closed Networks
Provider Ratings
Co-pay/ins differentials
PBA fund
Tiered Networks
“COE”-type Benefits
(travel, etc.)
Provider Pressure
Consumer Resistance
Low
High
Market-share/Volume Shift (DTC)
Provider Tiering
– Pacificare (CA), HealthNet (CA), Blue Shield (CA), Aetna (FL, TX, WA), Patient Choice Health Care (MN, CO, OR, MA)
Co-pay, co-insurance, premium differentials
– Hannaford Brothers
– $250 co-pay difference for employee going to hospital meeting the volume criteria for 5 of LF’s high risk procedures
– General Motors
– Adjusts employee premium contribution based on plan’s cost and quality performance
Health Plans Using or Planning to Use Leapfrog Criteria in Incentive Programs
Health Plan Brief Description of ProgramAnthem BCBS Midwest (KY, OH, IN) Agreement between Anthem and 38 hospitals (5 in KY and 33 in OH
and IN) which links reimbursements to quality measurements (CPOE included).
Anthem BCBS (VA) Awards for hospitals ICU staffing an d CPOE installation
Harvard Pilgrim Health Care/ Partners (MA) Rate increases based on patient safety measures identified by The Leapfrog Group as well as other performance measures
Empire BCBS (NY) Awards hospitals bonuses for meeting CPOE and IPS Leaps
BCBS (IL) Helps hospitals pay for electronic intensive care units
BCBS (MI) Rewards hospitals for including automated entry systems for prescriptions;
BS (CA) Tiers hospitals on cost effectiveness and good quality scores (uses LF)
HealthNet (CA) Incentive program modeled after Empire BCBS’s
Independence BC (PA) Rewards hospitals that meet LF standards and JCAHO’s performance criteria
Pacificare (CA) Tiers hospitals based on a number of variables including LF’s safety measures
Tufts/ Partners (MA) Contract with Partners' hospitals to provide financial bonuses for implementing "electronic systems" that improves the safety and efficiency
Tufts (MA) Tiers hospitals using quality and efficiency measures including CPOE and IPS
Regence BCBS (WA) Has plans to incent hospitals if fully-compliant with LF Leaps
Purchasers Using or Planning to Use Leapfrog Criteria in Incentive Programs
Purchaser Brief Description of Program
Pacific Business Group on Health (CA)
Places 2% of health plans’ premiums at risk- must meet targets to obtain full amount, one target being support of LF implementation
IBM, PepsiCo, Verizon, Xerox (NY)
Cooperate and pools funds with Empire BCBS to reward hospitals that meet the CPOE and IPS standards
Hannaford Brothers (ME) Applies an additional co-pay if an employee of theirs attends a hospital that does not meet the volume criteria for 5 out of the 7 LF high-risk procedures
Wisconsin Employee Trust Funds (WI)
Plans to evaluate health plans using HEDIS, The Leapfrog's recommended patient safety practices, and eventually the collecting and reporting of data around NQF's safe practices
Group Insurance Commission (MA)
The GIC has agreed to give their health plans financial bonuses if they meet standards for increasing admissions to Leapfrog-compliant hospitals
What’s in the Pipeline?
Pilot Type of Incentive
GE and Verizon; Albany, NY DFR and/or DTC
Boeing; Seattle, WA DTC- Payment Differential
Maine Health Management Coalition; Portland, ME
TBD
Healthcare 21; Eastern TN DTC- Tiering
AHRQ Incentive and Reward Pilots
Market-share/Volume Shift (DTC)
Creating Differential Hospital Insurance for Employees – The Boeing Company
Part of collective bargaining agreement with two largest unions
Effective July 1, 2004, union employees and early retirees will
obtain 100% coverage after deductible for services provided by
a Leapfrog-compliant hospital
Hourly employees hospitalized in facilities that do not meet the
Leapfrog safety practices will obtain 95% coverage after
deductible
This benefit design will remain in place until July 1, 2006 when a new collective bargaining agreement becomes effective
What’s in the Pipeline?
Leapfrog’s E 2 (Effectiveness and Efficiency) Hospital Rewards Program- Piggy-backing on CMS-Premier “Pay-for-Performance” Demo
–Actuarial analysis shows win for members–Data collection method already in place–No new measures–Plans can implement quickly for self-insured
or fully-insured customers–Can implement nationally or at local level–Can expand to other GPOs/Hospital groups
Other Incentives and Rewards Initiatives/Leverage Points
*I&R Toolkit
*I&R Compendium
Health Plan User Groups
*Standard Health Plan Contract Language
*eValue8 Common RFI
*Update of Economic Implications of original three leaps
Malpractice Study
* Found on Leapfrog Web site: http://www.leapfroggroup.org
Beginning to Leap Over Gridlock but Gaps Still Exist
Transparent Market- nationally standardized measures of quality and efficiency
Market Reinforcement- reward quality and efficiency and better demonstrate business case
Engage Consumers- aware of variation, mechanisms for timely and effective delivery of information, financial incentives
Engage Purchasers- including government- sufficient tools and critical mass
New health plan products
APPENDIX
Appendix A: NQF Safe Practices
27 Safe Practices from the National Quality Forum Safe Practices Consensus Report (May 2003): The report is available at www.qualityforum.org
Applicable to urban and rural hospitals
Rolled up measure of patient safety for release to public in August 2004
27 Safe Practices
1. Create a healthcare culture of safety
2. Ensure an adequate level of nursing care
3. Pharmacists available for consultation with prescribers on medication ordering, interpretation, and overall medication use process
4. Read backs to the prescriber5. Standardized abbreviations and
dose designations6. Patient care summaries or other
similar records should not be prepared from memory
7. Care information, especially changes in orders and new diagnostic information, is transmitted in a timely and clearly understandable form
8. Patient or legal surrogate can recount informed consent discussion
9. Patient's preference for life-sustaining treatments prominently displayed in record
10. Standardized protocol used to prevent the mislabeling of radiographs
11. Standardized protocols used to prevent wrong-site or wrong patient procedures
12. Evaluate and provide prophylactic treatment for patients at high-risk of acute ischemic cardiac event during surgery
27 Safe Practices, con’t
13. Evaluate each patient upon admission, and regularly thereafter, for the risk of developing pressure ulcers
14. Evaluate at admission (and treat), and regularly thereafter, for risk of deep vein thrombosis (DVT)/venous thromboembolism(VTE)
15. Utilize dedicated anti-thrombotic (anti-coagulation) services
16. Assess at admission, and regularly thereafter, patients for risk of aspiration.
17. Use effective methods of preventing central venous catheter-associated blood stream infections
18. Assess risk of surgical site infection; implement antibiotic prophylaxis and other measures
19. Reduce risk of renal injury based on the patient’s kidney function evaluation using standardized protocols
20. Evaluate risk of malnutrition, at admission and thereafter; employ clinically appropriate strategies to prevent malnutrition
21. When utilizing pneumatic tourniquet evaluate patient risk for an ischemic and/or thrombotic complication, and utilize appropriate prophylactic measures
22. Decontaminate hands with either a hygienic hand rub or by washing with a disinfectant soap after contact with patient or patient objects
23. Vaccinate healthcare workers against influenza
27 Safe Practices, con’t
24. Keep workspaces where medications are prepared clean, orderly, well lit
25. Standardize the methods for labeling, packaging, and storing medications
26. Identify all "high alert" drugs (e.g., intravenous adrenergic agonists and antagonists, chemotherapy agents, anticoagulants and anti-thrombotics, concentrated parenteral electrolytes, general anesthetics, neuromuscular blockers, insulin and oral hypoglycemics, narcotics and opiates)
27. Dispense medications in unit-dose or, when appropriate, unit-of-use form, whenever possible
Appendix B: Physician Office Clinical Decision Support
Rationale: E-PrescribingMedication errors affecting as many as 9% of prescriptions.
E-prescribing systems have the potential to improve quality and safety by:
– Eliminating legibility problems
– Reducing the occurrence of drug interactions, dosage errors, and other adverse effects by guiding prescribing based on computerized assessment of patient and medication information
Specifications: E-Prescribing
Physician office adopts and uses an electronic system which includes all of the following:
Decision support based on drug reference information
Patient-specific decision support database which includes age, weight, medications prescribed by that office, diagnoses, allergies, specified lab results, and electronically-available formulary information; inclusion of medications prescribed by other physicians is encouraged, but optional
Printing of a paper prescription or its NCPDP-compliant electronic transmission to the pharmacy
Rationale: E-Lab Results Management
Errors in managing lab results are common.
E-lab results management systems have the potential to improve quality and safety by:
Making a practitioner aware if lab test results which have been received have not been reviewed and/or shared with the patient
Reducing unnecessary test ordering by giving a practitioner easier access to previous lab test results
Specifications: E-Lab Results Management
Physician office adopts and uses an electronic system which includes all of the following:
Tracking whether results have been reviewed by the practice
Tracking whether results have been communicated to the patient, either electronically or via telephone or regular mail
Storage and retrieval of LOINC-compliant lab results reports (excepting microbiology) in database-structured format
Rationale: E-Care Reminders
Preventive services, or services recommended for chronic conditions, are underutilized. E-care reminder systems have the potential to improve quality and safety. Examples include:
Increase vaccination rates
Improved screening for breast cancer, colorectal cancer, cervical cancer, and other diseases
Improved cardiovascular risk factor reduction
Smoking assessment and counseling
E-Care Reminders, con’t.
Dietary assessment and counseling
Improved management of hypertension
Improved management of diabetes
Increased detection of medication errors and adverse drug events
Specifications: E-Care Reminders
Physician office adopts and uses an electronic system which includes all of the following:
Patient-specific database which includes age, gender, diagnoses, treatment codes, lab test results, and medications documented by a clinician, AND
Specified reminders for clinicians drawn from current US Preventive Services Task Force and other nationally recognized care guidelines (Appendix B)
Specifications: E-Care Reminders (2)
The electronic system enables all of the following clinician reminders:
Patients needing guidelines-based services at the time of patient contact
Patient lists for outreach communications to patients who require scheduling for guideline-based services
Generation of periodic reports of guideline-adherence rates for the physician office’s patient population as a whole
Recommended