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2011 National Healthcare Quality & Disparities Reports

The Agency for Healthcare Research and Quality has issued its ninth annual reports on the both the quality and disparities in health care. The goals of the reports were threefold:

  1. Address the status of health care quality and disparities in the U.S.
  2. Assess how quality and disparities have changed over time
  3. Show where there is need for improvement in quality and equity of health care

The reports used about 250 measures as benchmarks. The Quality report looked at overall quality measures for the nation, while the Disparities report looked at quality and access for racial, ethnic, and low-income groups or other populations such as rural residents, those with disabilities, and the lesbian/gay/bisexual/transgender population. The Quality report showed improvement in about three-quarters of the measures for acute illness or injury, and in about half the areas for preventive care and chronic disease management. The Disparities report found improvement in half the areas related to access, but 40% of the access measures worsened from previous reports.

Both reports looked at performance indicators for these areas:

Effectiveness of care for

  • Cancer
  • Cardiovascular disease
  • Chronic kidney disease
  • Diabetes
  • HIV and AIDS
  • Maternal and child health
  • Mental health and substance abuse
  • Musculoskeletal diseases
  • Respiratory diseases
  • Lifestyle modification
  • Functional status preservation and rehabilitation
  • Supportive and palliative care

Patient safety
Patient centeredness
Care coordination
Health systems infrastructure
Access to care

For each of the areas above, the report explains its importance to quality care, the performance measures used for assessment, and the findings.

Care coordination and health systems infrastructure were newly added to this year’s reports. To assess progress on care coordination, the performance assessment focused on transitions of care, integration of information, hospital readmissions, medication information, and preventable emergency department visits. On health system infrastructure, the report looks at use of electronic health records, workforce distribution, and the health care safety net.

Source: 2011 National healthcare quality & disparities reports. Agency for Healthcare Research and Quality, Mar. 2012. http://www.ahrq.gov/qual/qrdr11.htm

Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

15 Top Health Systems Based on Performance

Thomson Reuters has released its fourth annual ranking of the top 15 health systems in the U.S., based on an aggregation of  clinical quality and efficiency performance measures for each of their affiliated hospitals. Performance was assessed on mortality, complication, and patient safety indices, readmission rates, length of stay, and HCAHPS ratings on the patient experience. Median benchmarks in each performance category show how the top systems performed compared to others in their peer group.

The top performing systems in 3 ranges of operating expense size were:

Large systems [>$1.5 billion]

  • Banner Health [Phoenix AZ]
  • CareGroup Healthcare System [Boston MA]
  • Jefferson Health System [Radnor PA]
  • Memorial Hermann Healthcare System [Houston TX]
  • St. Vincent Health [Indianapolis IN]

Medium health systems [$750 million - $1.5 billion]

  • Baystate Health [ Springfield MA]
  • Geisinger Health System [Danville PA]
  • HCA Central & West Texas Division [Austin TX]
  • Mission Health System [Asheville NC]
  • Prime Healthcare Services [Ontario CA]

Small health systems [<$750 million]

  • Baptist Health [Montgomery AL]
  • Maury Regional Healthcare System [Columbia TN]
  • Poudre Valley Health System [Fort Collins CO]
  • Saint Joseph Regional Health System [Mishawaka IN]
  • Tanner Health System [Carrollton GA]

Source: 15 Top Health Systems: Study Overview and Research Findings. 4th ed. Thomson Reuters, Jan. 16, 2012.  http://www.100tophospitals.com/assets/15TopHealthSystems2012Abstract.pdf

Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

Research priorities report debuts

The Patient-Centered Outcomes Research Institute (PCORI), established by the Affordable Care Act, released its first major report on January 23, 2012 – Draft National Priorities for Research and Research Agenda – with a comment period open to the public until March 15.  The report does not identify specific diseases or conditions on which it intends to focus its generous funding ($4.5 billion through 2019); rather, it outlines broad categories under which research projects might be submitted for consideration:

  • Comparisons of prevention, diagnosis, and treatment options
  • Improving health care systems
  • Communication and dissemination
  • Addressing disparities
  • Accelerating patient-centered and methodological research

PCORI is looking for participation from patients, caregivers, researchers and the general public.  General information can be found at http://www.pcori.org/2012/priorities-agenda/.

Source:  Patient-Centered Outcomes Research Institute.  Draft National Priorities for Research and Research Agenda, Version 1.  January 23, 2012.  http://www.pcori.org/assets/PCORI-Draft-National-Priorities-and-Research-Agenda-2.pdf

Principles and Guidelines for Changes in Hospital Ownership

With renewed interest in clinical integration comes potential change in hospital ownership or control due to mergers/acquisitions, the formation of new integrated delivery networks, or the development of accountable care organizations.  To help  hospital leaders navigate the community interests and the regulatory requirements involved in an ownership change, the American Hospital Association and Jones Day have developed voluntary principles and guidelines.

The report discusses fiduciary duties in fulfilling the hospital’s mission, key considerations for potential control changes, and guidelines for review of possible ownership change. The guidelines cover:

  • Community engagement to identify future health improvement needs
  • Initial steps in considering a change
  • Evaluation of proposed changes
  • Conduct of  an appropriate review of state and federal laws
  • Appropriate antitrust analysis where necessary
  • Protection of the value of the community’s assets
  • Education of and communication to the community of the changes taking place

A comprehensive checklist of the documents needed for review of a proposed change in ownership is appended to the report.

American Hospital Association; Jones Day. Principles and guidelines for changes in hospital ownership. American Hospital Association, Jan. 2012. http://www.hpoe.org/hpoe/resources/hospital-ownership.pdf

Posted by the American Hospital Association Resource Center, (312) 422-2050, rc@aha.org.

Comparative National Health System Data for 40 Countries

OECD has released its annual report comparing health systems in its 34 member countries and, when information is available, 6 major non-OECD countries.

Data is provided for 8 broad categories:

  1. Health status [life expectancy, mortality, disease incidence, etc.]
  2. Non-medical determinants of health [tobacco and alcohol use, obesity]
  3. Health workforce [health sector employment, number and average income of physicians and nurses, etc.]
  4. Health care activities [hospital beds, discharges, average length of stay, medical technologies, pharmaceutical consumption, etc.]
  5. Quality of care [avoidable readmissions, patient safety, cancer care, vaccinations, etc.]
  6. Access to care [unmet health care needs, waiting times, inequalities, burden of out-of-pocket expenses, etc.]
  7. Health expenditure and financing [per capita and percent of GDP expenditures, expenditure by function, financing, etc.]
  8. Long-term care [a newly added section on LTC workers, beds, expenditures, etc.]

Also included is hard-to-find data on trade in health services, or medical tourism, showing both imports and exports [inbound and outbound medical travel] expenditures by country as a share of the nation’s total health expenditures and how that has changed from 2004-2009.

The member countries covered in the OECD report include:

  1. Australia
  2. Austria
  3. Belgium
  4. Canada
  5. Chile
  6. Czech Republic
  7. Denmark
  8. Estonia
  9. Finland
  10. France
  11. Germany
  12. Greece
  13. Hungary
  14. Iceland
  15. Ireland
  16. Israel
  17. Italy
  18. Japan
  19. Korea
  20. Luxembourg
  21. Mexico
  22. Netherlands
  23. New Zealand
  24. Norway
  25. Poland
  26. Portugal
  27. Slovak Republic
  28. Slovenia
  29. Spain
  30. Sweden
  31. Switzerland
  32. Turkey
  33. United Kingdom
  34. United States

The non-OECD member countries included when data is available are:

  1. Brazil
  2. China
  3. India
  4. Indonesia
  5. Russian Federation
  6. South Africa

If connected to the web when viewing the report, click on the StatLinks on individual tables and graphs to download the data to Excel.

Source: Health at a glance 2011; OECD indicators. Organisation for Economic Co-operation and Development, Dec. 2011. http://www.oecd.org/dataoecd/6/28/49105858.pdf

Posted by the AHA Resource Center, (312) 422-2050, rc@aha.org

New biennual survey of hospital governing boards available

The Governance Institute (www.governanceinstitute.com) has released the 2011 Biennial Survey of Hospitals and Healthcare Systems.  This is the first survey to look at governance structures in the post-Patient Protection and Affordable Care Act era, and new questions have been included to detect how hospitals are adapting to the shifting landscape.

As in previous years, the report is divided into two major sections – board structure and recommended practices adoption.  The 2011 survey includes a look at the prevalence of 95 recommended practices, several of which are appearing for the first time.  Commentaries on the survey results by recognized authorities – Don Seymour, Ed Kazemek, Ken Kaufman, and others – round out report.   

The report is available to Governance Institute members on the website; nonmembers may purchase the report.

Governance Institute.  Dynamic Governance: An Analysis of Board Structure and Practices in a Shifting Industry.  2011 Biennial Survey of Hospitals and Healthcare Systems.  Fall 2011.  http://www.governanceinstitute.com/ResearchPublications/ResourceLibrary/tabid/185/CategoryID/3/List/1/Level/a/ProductID/1199/Default.aspx?SortField=DateCreated+DESC%2cDateCreated+DESC

AHA releases new hospital database

The American Hospital Association has just released its FY 2010 Annual Survey Database. A comprehensive source of information on hospital operations, the database can be used for hospital and health system analysis, market research and development, and strategic planning.  It includes more than 1,000 fields of data on hospital utilization, staffing, services, expenses, and community involvement. New fields of data in FY 2010 are:

  • Physicians with shared responsibility for risk
  • Privileged physicians by relationship type
  • Number of hospitalists and intensivists
  • Advance practice registered nurses
  • Rural Health Clinic facilities
  • Staffing vacancies
  • Supply expenses

To view the survey questionnaire, click here. For the complete file layout, click here. For more information about the database, call the AHA Resource Center at (312) 422-2050.

Posted by the American Hospital Association Resource Center, rc@aha.org, (312) 422-2050.

Winning workplaces

Modern Healthcare recently published its 2011 Best Places to Work in Healthcare. Based on surveys of 327 health care organizations and companies that participated in the program, this list of the top 100  represents those who consistently received high scores for key workplace measures, including overall employee enasgement; work environment; role satisfaction; relationships with supervisors; corporate culture; leadership and planning; pay and benefits; and training and development.

Hospitals in the top 20 of the list are diverse in size and location:

  • Doctors Hospital of Sarasota, Sarasota, FL
  • Texas Health Harris Methodist Hospital Southlake, Southlake, TX
  • The Women’s Hospital, Newburgh, IN
  • Baptist Memorial Hospital-Union City, Union City, TN
  • Wamego City Hospital, Wamego, KS
  • Lovelace Women’s Hospital, Albuquerque, NM
  • Jacksonville Medical Center, Jacksonville, AL
  • Black River Memorial Hospital, Black River Falls, WI
  • Kootenai Health, Coeur d’Alene, ID

Seven hospitals and health systems have appeared on the top 100 list for all four years of the program:

  • Baptist Health South Florida, Coral Gables, FL
  • Holy Name Medical Center, Teaneck, NJ
  • Palmetto Health, Columbia, SC
  • Poudre Valley Health System, Fort Collins, CO
  • Saint Frances Medical Center, Cape Girardeau, MO
  • Valley Medical Center, Renton, WA
  • Woman’s Hospital, Baton Rouge, LA

Source: Modern Healthcare Best Places to Work. Oct. 24, 2011. http://www.modernhealthcare.com/article/20111019/INFO/310199975

Posted by AHA Resource Center, (312) 422-2050, rc@aha.org.

Hospitals and Care Systems of the Future

What do hospitals need to do to remain successful as the nation’s health system faces major changes? A new report from the American Hospital Association’s Committee on Performance Improvement identifies ‘must-do’ strategies and critical organizational competencies that hospitals will need to embrace for the future.

Must-do strategies identified for future success:

  1. Aligning hospitals, physicians, and other providers across the continuum of care
  2. Utilizing evidence-based practices to improve quality and patient safety
  3. Improving efficiency through productivity and financial management
  4. Developing integrated information systems
  5. Joining and growing integrated provider networks and care systems
  6. Educating and engaging employees and physicians to create leaders
  7. Strengthening finances to facilitate investment and innovation
  8. Partnering with payers
  9. Advancing through scenario-based strategic, financial and operational planning
  10. Seeking population health improvement through pursuit of the “triple aim

To plan for and implement these must-do strategies, hospitals will need to master these  core competencies:

  1. Design and implementation of patient-centered, integrated care
  2. Creation of accountable governance and leadership
  3. Strategic planning in an unstable environment
  4. Internal and external collaboration
  5. Financial stewardship and enterprise risk management
  6. Engagement of full employee potential
  7. Collection and utilization of electronic data for performance improvement

The report discusses each recommended strategy and competency. Self-assessment questions, performance metrics needed, and case examples are also included.

Source: AHA Committee on Performance Improvement. Hospitals and care systems of the future. American Hospital Association, Sept. 2011. http://www.aha.org/content/11/hospitals-care-systems-of-future.pdf.  Additional appendices: http://www.aha.org/content/11/hospitals-care-systems-of-future-appendix.pdf . Presentation slides: http://www.aha.org/content/11/hospitals-care-systems-of-future.pptx

Posted by AHA Resource Center, (312) 422-2050, rc@aha.org


Accountable care organization (ACO) survey results

The three largest accountable care organizations (ACOs), according to the number of covered lives are:

These results are from a survey of 13 ACOs, some in operation, some in developmental stages, conducted by Modern Healthcare magazine.  This cover story describes the survey participants and some of the issues encountered in formation of the ACO.  Of the seven ACOs that provided data on profitability, all were at least breaking even and the majority were profitable.

Source: Evans, M.  Forging the way.  Modern Healthcare;41(35):6+, Aug. 29, 2011.  Full text can be purchased from the magazine.  Start by clicking here: www.modernhealthcare.com  Posted by AHA Resource Center, (312) 422-2050, rc@aha.org


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