News Briefs
News Briefs
Business group leverages purchasing clout
A consortium of employers from the Washington DC-based Business Roundtable have pooled their formidable market power to address preventable medical errors. Known as "The Leapfrog Group," these 60 Roundtable members purchase health benefits for more than 20 million Americans.
Leapfrog members and their employees pump more than $40 billion annually into the health care industry. (In the October 2000 issue, QI/TQM covered the Leapfrog Group’s initial announcement of its purchasing principles. See "Group to make business case for patient safety," p. 113.)
Leapfrog is a voluntary program aimed at mobilizing large purchasers to alert the health care industry that big leaps in patient safety and customer value will be recognized and rewarded. Employers have agreed to base their purchase of health care benefits on principles encouraging more stringent patient safety measures. These measures include:
1. computerized physician order entry (CPOE);
2. evidence-based hospital referral;
3. intensive care unit (ICU) staffing by intensivists, physicians trained in critical care medicine.
Recent research conducted by Leapfrog indicates that the measures could save up to 58,300 lives and prevent up to 522,000 medication errors each year, if implemented by all nonrural hospitals in the United States.
• CPOE, in which computerized medication orders are linked to prescribing error prevention software, could reduce serious drug errors by more than 50%. Fewer than 2% of U.S. hospitals have CPOE completely or partially available and require its use by physicians.
Leapfrog purchasers cite the business sense for CPOE, using the example of Brigham and Women’s Hospital in Boston: The upfront implementation cost was $1.9 million, plus $500,000 for maintenance per year. The return on the initial investment has ranged between $5 million to $10 million per year.
• Evidence-based hospital referral for patients needing certain procedures to hospitals offering the best survival odds (based on valid criteria) could reduce the risk of death by more than 30%. Among the procedures are coronary artery bypass and coronary angioplasty. Leapfrog members will apply this standard only to hospitals in metropolitan areas.
• ICU physician staffing with specialists credentialed in critical care medicine could reduce the risk of dying in the ICU by more than 10%. The Leapfrog Group concedes that there are not enough trained intensivists available to staff each metropolitan ICU, so the standard will be applied broadly.
Members of the Leapfrog Group include:
• BF Goodrich/Rosemount Aerospace;
• DaimlerChrysler Corporation;
• Delta Airlines;
• Minnesota Mining & Manufacturing Company (3M).
For more information about the group’s standards, contact Lindsey Spindle, c/o Porter Novelli, 1909 K St., N.W., Washington, DC 20006. Telephone: (202) 973-2937. E-mail: Lspindle@ porternovelli.com. Web site: www.leapfrog-group.org.
Good patient care ideas deserve the limelight
Press, Ganey Associates teaches hospitals that when they provide stellar patient care service, profitability and healthy market share will follow. Last year, six hospitals proved this to a degree worthy of national recognition through Press, Ganey’s annual Client Success Story Winners 2000 award. The South Bend, IN-based firm has helped health care providers measure and improve patient satisfaction since 1985.
Here are the winners, along with thumbnail descriptions of their strategies for better patient service:
1. Hardin Memorial Hospital in Elizabethtown, KY. Reduced wait times in emergency, ambulatory surgery, and admitting.
2. Hays (KS) Medical Center. Put "meaning" back into health care for caregivers, patients, and their families.
3. MidState Medical Center in Meriden, CT. Practiced the center’s vision, "We will provide superior services that meet or exceed our customers’ expectations."
4. Newton (NJ) Memorial Hospital. Focused on excellence as "the way we do things around here."
5. Slidell (LA) Memorial Hospital. Produced an interactive, home-grown customer service training program instead of capitulating to budget shortages.
6. Trinity Medical Center in Rock Island, IL. Improved physicians’ customer service rankings through one-to-one coaching and group training.
The contest serves several purposes, according to Press, Ganey. It reflects the firm’s belief that no good idea should go unnoticed. Acclaim and recognition of success by individual organizations inspires collaboration and improvement throughout the health care industry. Press, Ganey grounds its work with clients in the philosophy that providing the best possible service to people in need of health care is the right thing to do.
For further information, contact Press, Ganey Associates, 404 Columbia Place, South Bend, IN 46601. Telephone: (800) 232-8032 or (219) 232-3387. Web site: www.pressganey.com.
(Editor’s note: Watch for project profiles of some of the Client Success Story 2000 winners in future issues of QI/TQM.) t
Why some older women don’t exercise regularly
Less than 10% of women over age 40 are physically active on a regular basis, according to a national study involving nearly 3,000 women 40 and older. Researchers found that physical inactivity may be due in part to not being around others who exercise. The majority of subjects report they would rather exercise on their own with instruction than participate in an instructor-led fitness group.
Among the reasons offered are for inactivity:
• lack of hills in the neighborhood;
• perceived poor health;
• infrequently observing others exercising in one’s neighborhood;
• caregiving duties.
The lack of hills as a barrier to physical activity surprised investigators led by psychologists Abby C. King, PhD and Cynthia Castro, PhD, both of Stanford University School of Medicine in Palo Alto, CA, and epidemiologist Ross C. Brownson, PhD, of St. Louis University. They write, "It is possible that hilly neighborhoods provide more interesting scenery in which to undertake physical activity." Or women might consider physical activity in hilly terrain as genuine effort and report it as such, while activity on flat terrain might not be perceived as worth mentioning.
Reports of caregiving as a barrier to physical activity were similar to outcomes from a recent European study. The authors note that these results underscore the need to identify the types of fitness activities appropriate to caregivers’ circumstances.
The data were collected during a 12-month period from an ethnically diverse sample of white, African-American, Hispanic, and American Indian-Alaskan Native women. Physical activity level was divided into three categories:
• Sedentary, defined as no sports or exercise reported in the past two weeks or no increase in heart rate from any activities.
• Underactive, not meeting the criteria for either the sedentary or active category.
• Active, three or more sessions per week, for at least 20 minutes each, of jogging-running, hiking, biking, swimming, or dance resulting in a medium to large increase in reported heart rate; or five or more sessions per week, for at least 30 minutes per session, of any physical activities that resulted in at least some increase in reported heart rate.
The finding that 9% of middle- and older-aged women engage in regular physical activity is comparable to the results of other studies. The largest percentages of women falling into the inactive category were American Indian-Alaskan Native (59%) and African-American (57%).
Other factors associated with inactive lifestyles were limited education, older age, and lack of energy. Two-thirds of the respondents from all four racial-ethnic subgroups and from each of the three defined physical activity categories expressed their preference for undertaking an activity on their own with some instruction. The researchers observe that this probably reflects the influence of convenience and flexibility in people’s physical activity choices.
[See: King AC, Castro C, Wilcox S, et al. Personal and environmental factors associated with physical inactivity among different racial-ethnic groups of U.S. middle-aged and older-aged women. Health Psychology 2000; 19(4):354-364.] t
Latest health statistics: Mammogram rates climb
Breast cancer screenings are up for women aged 50-plus, according to figures recently compiled by the National Center for Health Statistics (NCHS) in Hyattsville, MD. The increases are substantial among women from all income levels. However, poor women are still less likely to receive mammograms than their contemporaries of higher means. Among women living below the poverty threshold in 1998, 53% reported recent screening compared with 72% of women at or above it.
The recently released 1998 figure of 69% for the entire 50-plus age group is up from 61% in 1994. This is 2½ times the 1987 total of 27%. Age-adjusted death rates from breast cancer fell to 19 deaths per 100,000 in 1998, down from 23 in 1990.
At the other end of the age spectrum, children living in poverty were 50% more likely than non-poor children to have a recent emergency room (ER) visit in 1998. Older teenagers are more likely than pre-teens or younger teenagers to die from motor vehicle or firearm injuries. Older teens are more likely to visit the ER with an illness or injury; and more likely to smoke, binge drink, or use marijuana. Sexual activity increases with age through the teen years, as does the likelihood of sexually transmitted disease.
To learn more, contact the National Center for Health Statistics, Division of Data Services, Hyattsville, MD 20782-2003. Telephone: (301) 458-4636. Web site: www.cdc.gov/nchs.
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