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It's Impossible to Know What $1B in Federal Quality Spending Buys

Cheryl Clark, for HealthLeaders Media, February 20, 2014

First, he says, many of the measures used in both the HEN project and Premier's Quest, "are of low validity, with data varying among sites and limited quality control." And, he points out, there's no peer review of the results, and "no public reporting of how accurate they are. There's a reason why peer review is important; it assures us that the science passes the smell test."

Second, the projects lack control groups. "Hospitals all over the country are working on this stuff," with dozens of other projects, Pronovost says, "so that makes it difficult to attribute the results to one particular intervention."

For example, while the Quest program receives no federal funds, a large number of its participating hospitals are also in Premier's HEN, which does get federal money.

In planning the design of the HEN programs, which target 10 types of hospital harms, officials with the Centers for Medicare & Medicaid Services "didn't standardize the collection of data, Pronovost says. "It was like 'let 1,000 flowers bloom.' I recall pushing back on that, saying, 'if you do that you'll never be able to say how big of an impact these really had.' "

Ashish Jha, MD, professor of health policy and management at Harvard School of Public Health, quipped, "I'm fine with letting 1,000 flowers bloom. But we'd love to know which flowers actually bloomed, and which ones didn't."

A huge amount of this is taxpayer money, after all.

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3 comments on "It's Impossible to Know What $1B in Federal Quality Spending Buys"


Kate ONeill, MSN, RN (2/22/2014 at 8:00 PM)
Dear Cheryl, THANK YOU for post and a great read. Please let me share with you and the US taxpayers some interesting information. I'm the new VP of Quality and Safety at CloseCareGap, PSO. We were approved as a Patient Safety Organization in July 2013. Over the past 6 months, we have contacted many HEN organizations at the national and state level with little avail to collaborate with our benefit PSO organization. CCG has built a sustainable solution (real-time), a smart app, to measure variances and gaps in practice around the HEN top 10 core areas of harm. Our solution is FREE to hospital organizations and publicly available at http://www.icarequality.org/closecaregap.html . We have yet hear back from any HEN's who are interested in our solution to partner with us to collaborate and improve care delivery together at the bedside. Furthermore, when we submitted information about CCG to the federal agency in December 2013, they did not even have Nursing as a profile as a specialty discipline. How could the federal government not even have "Nursing" listed to help improve care delivery on the frontline? Where has billions of tax dollars been spent over the last few years since the notorious IOM report? Please feel free to comment or contact CCG if we can improve care delivery together. We welcome joint collaboration to improve care quality and safety. Patients and taxpayers expect more and deserve more if work together for a better solution. Kate at kate.oneill@icarequality.org

Sandra Trotter (2/22/2014 at 1:47 PM)
The two main themes seem to be about the data validity and the attributing the improvements solely to the HEN interventions. For the data validity- the top measures, which are used in the calculations,are all standard measures and definitions that many researchers use to validate improvements (NHSN,Joint Commission Core Measures,Leapfrog,CMS, etc). I agree it's not perfect data but it is a mistake to say that it is not standard data routinely used for healthcare quality comparisons. For attribution- no one can claim "sole" credit for hospital improvement because hospitals don't exist in a vacuum. This is even more true for these hospitals because collaboration is built in by design. The Hospital Engagement Networks (HENs) are part of Partnerships for Patients which is a coming together of many organizations including TJC, CMS, NQF, etc to share and learn from one another. I personally think this is a very exciting time in healthcare. I work with hospitals in California and I am seeing across the state, great strides to improve patient safety and quality of care at our hospitals. Sandra Trotter, MBA, MPHA, CPHQ

Vicky Mahn-DiNicola (2/20/2014 at 4:19 PM)
I agree that the data that is collected by the 26 HENS may not be held to robust data integrity standards that physicians and researchers would prefer to see. However, the mission of the HENS was to motivate and accelerate shared learning across facilities. The purpose was not benchmarking. Having said that, since most of the measures collected by the HENS are in fact redundant to other quality reporting programs that do hold to high standards of data integrity (such as "Core" measures, NHSN measures etc.) we might infer that the data collection methodologies are in fact sufficient for hospital comparison purposes. The real issue however is not that the data lacks standardized methodologies for collection and reporting. The greatest challenge is perhaps that these rate based quality measures are simply not designed to show correlations between process and outcome. The next generation of analytics that will arise from machine learning methodologies and unveil correlations between what works and what doesn't work to achieve our desired outcomes will accelerate our learning. Realistically, it will take time to build our health information technology foundations and intraoperability standards. Until then, the clinical collaboratives are helping us take small steps forward until we are ready to leap. Vicky A. Mahn-DiNicola, RN, MS, CPHQ, VP Research & Market Insights, Midas+, A Xerox Company.