June 22, 2012
Excerpt:
In this commentary, we hope to stimulate innovation in the field of health care performance measurement. We will discuss several considerations regarding the use of three quality indicators that are commonly used to improve accountability in the Canadian context. Specifically, we will focus on the hospital standardized mortality ratio (HSMR), all-cause urgent readmissions, and emergency department length of stay (ED-LOS; see Textbox 1). We discuss “the good,” “the bad,” and “the ugly” to illustrate both positive and negative consequences related to measurement. We conclude with specific recommendations regarding investments to improve quality measurement.
Posted in Journal Articles, READ Portal | Tagged with Benchmarking, Canada, Indicators, Mortality rates, Program evaluation, Statistics & numerical data | No Comments
November 16, 2011
“Objective: To determine whether patients who are not admitted to hospital after attending an emergency department during shifts with long waiting times are at risk for adverse events.
Conclusions: Presenting to an emergency department during shifts with longer waiting times, reflected in longer mean length of stay, is associated with a greater risk in the short term of death and admission to hospital in patients who are well enough to leave the department. Patients who leave without being seen are not at higher risk of short term adverse events.”
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Posted in Journal Articles, READ Portal | Tagged with Mortality rates, Risk assessment, Statistics & numerical data, Wait lists | No Comments
September 9, 2011
Despite extensive ongoing quality improvement (QI) efforts, substantial variation existed in hospital standardized mortality ratios (HSMRs) across hospitals in Kaiser Permanente, an integrated health care delivery system. In 2008, Kaiser Permanente developed an efficient and effective method for investigating hospital-level mortality to identify patterns of potential harm.
The mortality review process, which included quantitative data from structured chart abstraction and qualitative description of harm events, efficiently gathered important information on patterns of mortality that was not otherwise available, enabling hospitals to identify trends and focus improvement efforts.
Posted in Journal Articles, READ Portal | Tagged with Mortality rates, Quality improvement, Trends | No Comments
July 21, 2011
Doctor’s attitudes and behaviours can have a huge impact on patient health and safety, according to new data collected by Dr. Andrew Klein, Cedars Sinai Director of Comprehensive transplant center at, and Dr. Pier Forni, founder of the Johns Hopkins Civility Project at Johns Hopkins University.
Klein and Forni accumulated data from a number of studies that look at how doctors behave towards operating room staff, nurses, and pharmacists, and came to the conclusion that doctor civility is of critical importance. In operating rooms, doctor discourtesy to staff is linked to higher incidences of post-operative complications and even mortality rates. In hospital pharmacies, pharmacists won’t ask a doctor that they perceive to be “mean” for clarification regarding prescriptions, which can have serious impact on patients well-being.
While doctors themselves obviously are responsible for their own behaviour, the root of the problem lies in medical culture itself. According to Klein this problem is cyclical, as rude doctors bully their students which “essentially train(s) the next generation of surgeons to be bullies.”
READ wants to know: how does your organization encourage doctors to maintain a professional and pleasant manner with others? What challenges do you face in the process?
Posted in Mass Media Articles, READ Portal | Tagged with Mortality rates, Patient-centered care, Safety | No Comments
June 10, 2011
“Fueled by a growing number of studies reporting inverse relationships between hospital volume and surgical mortality, there was considerable interest in the United States during the previous decade in concentrating selected operations in high-volume hospitals. The Leapfrog Group, a consortium of large corporations and public agencies that purchase health care, has been among the most prominent advocates of volume-based referral. In 2000, it established minimum volume standards for several surgical procedures as part of a broader, value-based purchasing initiative. Private payers and professional organizations in the United States have also established minimum volume standards as part of Centers of Excellence accreditation programs for a variety of operations.
Whether such efforts have altered referral patterns for high-risk surgery remains uncertain, however. There are still many barriers to regionalization, including patient preferences for local care, financial incentives for smaller hospitals to retain surgical cases and lack of access to high-volume centers in some regions. Despite increasing numbers of surgical patients in high-volume hospitals, the net effects on operative mortality are difficult to predict. Although hospital volume of a few high-risk cancer procedures (e.g., pancreatectomy) is a strong predictor of operative risk, relationships between volume and outcome are considerably weaker for most operations.
In this study, we used data from national Medicare claims to evaluate trends in the use of high-volume hospitals for major cancer resections and cardiovascular surgery. We also examined concurrent trends in operative mortality rates associated with these procedures and the extent to which decreases in mortality could be associated with a concentration of surgical care in high-volume hospitals.”
Posted in Journal Articles, READ Portal | Tagged with Mortality rates, Quality of care | No Comments
June 2, 2011
“Context:The association of an adult tele-intensive care unit (ICU) intervention with hospital mortality, length of stay, best practice adherence, and preventable complications for an academic medical center has not been reported.
Objective: To quantify the association of a tele-ICU intervention with hospital mortality, length of stay, and complications that are preventable by adherence to best practices.
Conclusion: In a single academic medical center study, implementation of a tele-ICU intervention was associated with reduced adjusted odds of mortality and reduced hospital length of stay, as well as with changes in best practice adherence and lower rates of preventable complications.”
Posted in Journal Articles, READ Portal | Tagged with Health technology, Information technology, Mortality rates, Technology | No Comments
May 6, 2011
“As part of a systemwide transformation, the VA formed its National Center for Patient Safety to foster an organizational culture of safety within its nationwide network of hospitals and outpatient clinics. A recent medical team training program designed to improve communication among operating room staff was associated with a reduction in surgical mortality and improvements in quality of care, on-time surgery starts, and staff morale. The program is now being expanded to other clinical units, along with a patient engagement program that prevents errors by facilitating communication relating to patients’ daily care plans. A recognition program stimulated facilities to conduct timelier and higher-quality root-cause analyses of reported safety events to identify stronger actions for preventing their recurrence. Other initiatives have reduced rates of health care–associated infections, patient mortality, and post-operative complications. Success factors include leadership accountability for performance and organizational support for testing, expanding, and adopting improvements.”
Posted in Journal Articles, READ Portal | Tagged with Benchmarking, Efficiency, Mortality rates, Quality control, Quality improvement, Safety | No Comments
January 3, 2011
Over the past decade, infectious diseases have regained prominence in Ontario, with outbreaks of E. coli O157:H7, West Nile virus, severe acute respiratory syndrome (SARS) and pandemic H1N1 influenza. The Ontario Burden of Infectious Disease Study (ONBOIDS) provides a current assessment of the mortality and morbidity of infectious disease in the province.
The study looked at 51 different sources of infectious disease to estimate their impact on the life and health of Ontarians and found a few surprises. In fact, many of the infectious diseases ranked highest in terms of impact get little recognition in terms of public awareness, media attention and resource allocation.
Posted in READ Portal, Reports & Papers | Tagged with Canada, Mortality rates | No Comments
December 20, 2010
The objective of this research was to develop a case finding method that can be used as the basis for an hospice or palliative care referral for inpatient cancer patients. This was a retrospective study using secondary data from administrative sources. The analysis used five years – FY2001 through FY2005 – of inpatient data from the VA National Patient Care Database (NPCD) to identify patients.
Posted in READ Portal, Working Papers | Tagged with Cancer, Hospice care, Mortality rates | No Comments
November 11, 2010
Early treatment with rt-PA is critical for favorable outcome of acute stroke. However, only a very small proportion of stroke patients receive this treatment, as most arrive at hospital too late to be eligible for rt-PA therapy.
Posted in Journal Articles, READ Portal | Tagged with Efficiency, Emergency service, Mortality rates, Safety | No Comments
