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How Will Partnership for Patients Reduce Medical Harm?

Cheryl Clark, for HealthLeaders Media, April 21, 2011

The administration promises to spend $1 billion allocated from health reform legislation on the effort, specifically to help coalitions of providers, state agencies, employers, insurance companies and others who have proven strategies for success show others how to achieve these goals. And as of Wednesday night, nearly 1000 hospitals, medical groups, and clinicians had signed a pledge to participate, as well as 256 patient advocacy groups or health plans, consumer groups and employers.

Some hospital officials are hopeful, but skeptical.

Jim Lott, executive vice president of the Hospital Association of Southern California, which represents 180 hospitals and 40% of the acute care beds in the state, says he doesn't fully understand the program or what it seeks to accomplish. He thinks perhaps the White House is feeling pressure to get something off the ground.

"I've got to believe some of this is prompted by the political activity regarding the Affordable Care Act, and the fact House Republicans want to defund all these initiatives, particularly those that give the Secretary this kind of discretion," he says. "The sooner the administration gets these types of preventive initiatives in place, the better argument they can make for their funding."

Lott says that he wishes the administration didn't feel so much pressure. "They need to slow down and find out what is the best use of that money," he said. California, he notes, already has just that kind of program already in place.

Joe McCannon, senior advisor to CMS administrator Don Berwick, MD, and the advocate who ran the Institute for Healthcare Improvement's "Protecting 5 Million Lives from Harm" campaign, explains the program this way:

Take ventilator-associated pneumonia, a hospital-acquired infection that the Partnership's research team estimates is 50% preventable, he says. The Partnership wants hospitals to reduce those cases by that amount by 2013, or about 17,500 cases.

McCannon says hospital teams learn from strategies shown to work elsewhere, such as elevating the head of a patient's bed to reduce the risk of aspiration, adjusting sedation to allow patients to follow commands, and better weaning strategies to reduce the time the patient is on the ventilator, he says.

Don't hospitals already do those things, and in spite of it VAP still occurs at alarmingly high rates? I ask.

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1 comments on "How Will Partnership for Patients Reduce Medical Harm?"


Bryan A. Liang (4/21/2011 at 1:30 PM)
Notwithstanding the theoretical benefits of Partnership for Patients, politics has ultimately played a significant role. As noted, the current initiative will *not* require public reporting of individual hospital performance. Rather than having each facility report results on reaching quality and safety targets, only aggregate goals and figures are to be used. Hence, potential strides for improvement of transparency and accountability in patient safety have been thwarted. Transparency is critical to any improvement in the safety realm, as is patient engagement in the process as a member of the safety team. Any safety initiative must, at a minimum, provide for individual hospital accountability through widely available public information about quality and safety measures within that facility. Moreover, patient-centered care and informed consumer choice can only be achieved through public reporting of patient satisfaction scores to demonstrate a facility's responsiveness to patients as the true center of the delivery process. Unfortunately, it is exactly these key indicia that have been removed from the initiative. Last year, when the initiative was supposed to be announced, consumer groups and large employer customers stressed public reporting was essential for individual hospitals to drive accountability and to supplant public value-based purchasing efforts with private-sector ones. Indeed, the administration solicited large employers (although not patients) for input regarding the initiative and tying payments to reporting and reaching quality measures. Instead of integrating input and promoting accountability by designing hospital systems that fulfill transparency, quality, and safety information needs, CMS This compromises the ethic of transparency, and the initiative actually represents two steps back in attempting to improve the current dismal state of patient safety. The dismal state of affairs of US patient safety means we need *more* accountability and *more* transparency, not less. Moreover, publicly reported scores at the hospitalcompare.hhs.gov website show that hospitals are receiving an F grade- scores of 55% or lower- for patients willing to recommend the facility to others, indicating an even greater need for individual hospital information. Patient access to safety, quality, and satisfaction information about individual institutions is the only road to informed consumer choice and thus improved accountability and competition. Innovative hospitals with outstanding quality and safety should not wait for CMS to change its approach. In parallel to advocating for accountability, these facilities should be trumpeting their transparency in open reporting of their patient safety and quality improvement activities compared with competitors. They should aggressively advertise their own high scores, and make direct comparisons to competing facility reported outcomes using hospitalcompare.hhs.gov available information. This approach can at least partially mitigate the impact of a policy that obscures how well facilities are actually performing. Transparency, accountability, quality, and safety[INVALID]these are all tenets constantly repeated by policymakers as their supposed focus in reform. It is time to clearly and unequivocally focus on the patient: The patient must have all relevant information to make an informed choice as to the facility that provides the highest quality and safest care with the best attention to patient experience and partnership. Quality and safety reporting for all providers is the foundational aspect of that focus. Patient safety advocates must ensure that policymakers are reminded that patients are entitled to safety and quality information as they remain the ultimate payers and the ultimate party who must shoulder the burden of poor healthcare quality and safety outcomes common in the United States health delivery system today. Bryan A. Liang, MD, PhD, JD, is Shapiro Distinguished Professor of Health Law and Executive Director, Institute of Health Law Studies, California Western School of Law; and Professor of Anesthesiology and Director, San Diego Center for Patient Safety, UCSD School of Medicine.