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

Cheryl Clark, for HealthLeaders Media, February 20, 2014

"The way some of these projects were set up, they weren't really designed to collect data in a standardized way, and they weren't set up for people to learn in real time. But I suspect that at the end of the day, they will find certain core practices that are really important, and there'll be a lot of emphasis on adapting them in a flexible way," so they work in multiple hospital settings.

"A lot of people wanted to tackle these tough problems at once, and that was a good thing…And at the end of the day we will have some really great lessons people can run with," Goldmann told me.

I asked Pronovost if it might all be worth it if at the very least, all these programs forced hospital leadership and their trustees to take quality improvement more seriously. Yes and no, he says.

One risk is that "it disengages physicians who don't believe there's science behind them, that this is just marketing. The early quality improvement movement had all these hyperbolic 'we are filling the football stadium with all the people whose lives we saved' statements, and that turned physicians away," Pronovost says.

"All of us want to help, not harm patients, so there's an amazingly strong bias that we want the data to get better. We all want the story to be true.

The problem is at the end of the day, if it's not better, [patients] are still dying, and yet we all clap our hands and say look, what a good job we've done."

Is it a case of the emperor having no clothes?

"The emperor may be wearing clothes," Pronovost says, "but you certainly can't say he's wearing a gold robe."


Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
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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.