Qual­ity con­trol

As strug­gles with cost and qual­ity con­tinue, sim­ple mea­sures are worth a shot

Modern Healthcare - - Opinions Editorials - DAVID MAY As­sis­tant Man­ag­ing Editor/fea­tures

In any given con­ver­sa­tion about U.S. health­care, it’s al­most a sure thing that the word “cost” will quickly come into play, es­pe­cially given to­day’s po­lit­i­cal and eco­nomic re­al­i­ties. But you’ll just as likely hear talk about “qual­ity”—prob­a­bly com­plaints about why there’s not nearly enough of it in light of our na­tion’s bloated health­care spend­ing.

So are cost and qual­ity cor­re­lated? Of course they are, with study af­ter study point­ing to sub­par care—and all its at­ten­dant ex­tra ser­vices and ex­pense—as help­ing to drive the cost curve ever higher. Think of hos­pi­tal-ac­quired in­fec­tions and need­less read­mis­sions as just two ex­am­ples.

For fur­ther com­pelling ev­i­dence of an in­ter­con­nec­tion, I urge you to read a re­port by Modern Health­care’s Joe Carl­son in the spe­cial sup­ple­ment ac­com­pa­ny­ing this week’s is­sue (also avail­able at modern­health­care.com/100tophos­pi­tals for online read­ers). The story is based on exclusive re­search con­ducted for Modern Health­care by Thom­son Reuters that pro­vides strong ev­i­dence of how lower spend­ing on drugs and other sup­plies at high-per­form­ing hos­pi­tals can lead to im­proved qual­ity while at the same time trim­ming ex­pense. In an era of ex­cep­tion­ally tight re­sources, it’s ex­cit­ing to see proof that it’s pos­si­ble to ac­com­plish more—clin­i­cally and fi­nan­cially—by con­sum­ing less.

Cer­tainly the most cost-ef­fec­tive form of health­care is when no care is de­liv­ered at all be­cause it just isn’t nec­es­sary. It’s when the need for health­care is pre­vented. And when health­care isn’t pro­vided, it’s much harder to make an egre­gious med­i­cal er­ror or com­mit mal­prac­tice.

We’re all aware of our per­sonal re­spon­si­bil­i­ties on the pre­ven­tion front to help keep us out of the hos­pi­tal. Col­lec­tively as a na­tion we’re too seden­tary and carry too many pounds, plac­ing us at higher risk for heart dis­ease, di­a­betes and other ill­nesses. Large numbers of us still smoke, aren’t get­ting enough sleep and face an over­load of stress. That’s what pub­lic health ex­perts and prob­a­bly our own doc­tors have been telling us for a long time now. It’s time to lis­ten and take ac­tion.

But when it comes to pre­ven­tion, health­care providers also need to lis­ten and make some changes of their own. Is ev­ery­one re­mem­ber­ing to wash their hands? Yet an­other study, this one pub­lished in the Septem­ber is­sue of the Amer­i­can Jour­nal of In­fec­tion Con­trol, in­di­cates that poor hand hy­giene con­tin­ues to be a prob­lem among health­care pro­fes­sion­als. The same study warned that doc­tors’ white coats and nurses’ scrubs also of­ten har­bor dan­ger­ous bac­te­ria, rais­ing the in­fec­tion risk. So ap­par­ently, care­givers not only aren’t wash­ing their hands of­ten enough, they also could use some help with their dirty laun­dry.

Mean­while, with an­other flu sea­son ap­proach­ing, the Cen­ters for Dis­ease Con­trol and Pre­ven­tion con­tin­ues to rec­om­mend that nearly ev­ery­one re­ceive an an­nual flu shot to help lower the risk of in­fec­tion. For some rea­son, how­ever, sur­pris­ingly large numbers of health­care providers choose to ig­nore this ad­vice and forgo vac­ci­na­tion. Ac­cord­ing to a CDC re­port from mid-Au­gust cit­ing data from the 2010-11 flu sea­son, only 63.5% of health­care work­ers over­all got a flu shot. The per­cent­age was high­est among those work­ing at hos­pi­tals, 71.1%, while lower at long-term-care fa­cil­i­ties and among home health work­ers, 64.4% and 53.6%, re­spec­tively.

With in­fluenza peren­ni­ally among the 10 lead­ing causes of death, for health­care providers to put up those numbers is quite shame­ful, es­pe­cially for care­givers work­ing with frail se­niors, the most vul­ner­a­ble. The time might be at hand for com­pul­sory vac­ci­na­tion for all.

For very lit­tle cost, health­care providers have it within their power to con­tinue mak­ing qual­ity strides. To a great ex­tent, it’s lit­er­ally in their hands. And their arms.

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