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Medical Harm Complaint System Could be Quality Data Goldmine

On Behalf of | Oct 21, 2012 | Uncategorized

A first-of-its kind federal pilot project designed  to make it easier for patients to directly complain about medical errors,  safety issues, and harm may prompt some doctors and hospitals to blanch.
Might it unleash a gripefest about relatively unimportant aspects of care, like  the yucky taste of hospital food, the lack of parking, or meandering laments  that one got sick in the first place? A rage against the night?
Are most patients even sophisticated enough about the healthcare system to know  a medical error or an unsafe condition when they see one, or how to distinguish  it from the natural course of their disease?
With the Office of Inspector General’s estimate that one in four Medicare patients  suffers harm at the hands of healthcare providers, could this new information  really give providers any more information than by now, they must already know?
We may soon find out.
The pilot project proposed by the federal Agency for Healthcare Research and  Quality (AHRQ) intends to give such a harm complaint system a trial run  sometime next year, probably in the mid-Atlantic region near Philadelphia. Many  say the information it will produce will be a goldmine for quality improvement.

How were you harmed?

Among the proposed  queries: Who made the mistake? Where, why, and how? Did it involve a  medication, test, or procedure? Was there a delay in care or diagnosis, a  problem with anesthesia, or “bad” medical advice?
Patients would be asked how they found out about the error or unsafe condition  and the extent to which the harm or error affected them. For example, did it  cause them to miss work or pay for more tests and procedures, or make more  trips to a healthcare facility?
The proposed questionnaire also asks if providers made any special effort to  help patients handle the negative effect, and whether that effort indeed helped.
Providers linked to the incidents would be notified “so they can do a  better job.”
According to an analysis of the prototype’s costs, a healthcare organization  that received 924 responses or complaints might spend $11,537 logging in the information  and conducting follow-ups. The AHRQ project goes way beyond the Hospital  Consumer Assessment of Healthcare Providers (HCAHPS) surveys, which ask how  patients think they were treated in the hospital, not whether they witnessed  errors or harm in the process of their care.

Part of a safety scoring trend

We know medical  error and unsafe conditions are of enormous interest to payers and patients,  and increasingly to providers.  The  Leapfrog Group and Consumer  Reports this  year each launched their own hospital safety rating systems. But those  algorithms don’t report actual harmful events as the AHRQ system would.
While a few hospitals around the country may have plans for internal systems to  elicit information from patients about harm or errors they experienced, nationally, no such effort yet exists.
A study of inpatients treated at a Boston teaching  hospital in 2003 revealed patients can accurately  relate problems,  mistakes and injuries in their care, including near misses verified, but not  documented in the patient’s medical record or its incident reporting system.
AHA support

I  thought the American Hospital Association would be nervous about such an  effort. But Nancy Foster, the AHA’s vice president for quality and patient  safety policy assures me that such a system can inform the patient care process  about problems that providers themselves can’t see.

She likens it to feedback a dissatisfied consumer is able to give to the  manufacturer.
“Patients may be most ideally positioned to tell us when they’re getting  discordant advice from different clinicians,” Foster says. “Maybe a  patient was supposed to go into surgery at 10. They got pre-op medications  then. But then the surgery was delayed until 4, and they didn’t get the  medications again.  They don’t know  whether they should have gotten the medications again, but they do know enough  to ask the question.”

She acknowledges, however, that there could be “a lot of noise in the data  collection, things that aren’t real signals of patient safety issues. And if  that’s what AHRQ finds out when it experiments with this, my guess is that they  will conclude it wasn’t all it was cracked up to be. They may redo the  questionnaire to target concerns more effectively or will abandon the notion.

“But until we try, we really won’t know.”

Potential for arrogance

Barbara  Balik, a  senior faculty member of the Institute for Healthcare Improvement and a former quality  executive with Allina Hospitals and Clinics in Minnesota, was on the AHRQ task  force that developed the prototype concept three years ago.

She says research shows that even though patients may not understand the inner  workings of the healthcare system, “when they get some signals that  something in their care isn’t going well, there’s a strong correlation with the  quality and outcomes of care.”

She adds, “I  think there’s the potential for arrogance on the healthcare provider side, to  say that patients don’t know what they’re talking about.   Yes they do. They know what it sounds like,  looks like, and feels like from their standpoint, and that’s the voice we have  to hear. It’s an amazing source of insight and advantage that we can take  advantage of.”

AHRQ officials can’t yet say precisely when or where the prototype will be  launched, but I’ll be looking to see how care might improve as a result.

As Foster says, “until we try, we really won’t know.”

Source: Health Leaders Media at

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