Measure What Matters: Preventing Medical Harm in Long-Term Care Facilities 

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By Frank Mazza

An estimated 440,000 patients die in American hospitals every year due to medical errors, according to the Journal of Patient Safety. The implications of this statistic for healthcare are staggering. In fact, it represents the equivalent of eight fully loaded Boeing 737 jets crashing each day with loss of life of everyone on board. 

The result has been the spawning of a national quality and patient safety movement intended to eliminate the risk of harm for patients admitted to American hospitals.  Numerous stakeholders at all levels, including the highly regarded Pennsylvania Health Care Quality Alliance, have moved with due speed to prevent and mitigate harm as part of this effort.

Overall, Pennsylvania hospitals have performed well in relation to the rest of the country. Unfortunately, despite the concerted efforts of hospitals across the state, only heart attack mortality has seen a consistent reduction among three major illness categories measured by the federal Center for Medicare and Medicaid Services (CMS), and readmissions to hospitals within 30 days. These rates are almost identical with national rates.

When errors occur, it is essential for long-term care facilities and other healthcare organizations to understand why they occurred and learn from the errors to prevent future death or serious injury. Medical data analytics that help organizations to monitor, manage and report errors and adverse events will play a central role in realizing the delivery of safer, higher quality care. 

Industry purveyors who design useful and usable solutions for this purpose will best position themselves to effectively meet the expectations of both providers and payers if they can provide a unique blend of functionality that centers on three fundamental areas:

  • Safety Risk Management and Surveillance
  • Pay-for-Value Reporting
  • Performance Analytics

As part of this offering, the combination of SaaS-based solutions and information services should be made available, either on a standalone or fully integrated basis, to more effectively monitor and measure clinical and financial performance with precision and conviction.

Measure What Matters

As payments become increasingly and explicitly linked to a complex myriad of performance measurements, non-performing providers will face greater financial risk. These facilities should aim to optimize their day-to-day operations. In order to unlock value in healthcare and see improvements in quality and safety, there must also be a commitment to standardizing their approach to the treatment of major medical conditions and measuring their outcomes.  

The key is to unlock all of the benefits of value-based healthcare, keeping in mind that this requires a clear commitment to measuring a minimum set of outcomes for every major medical condition, and standardizing them.  Information technology vendors must take the lead in embedding standardized order sets and clinical processes into electronic medical records, and in creating software solutions that automate and aggregate outcomes-data collection. A data platform that allows provider benchmarking based upon resource utilization and condition-by-condition clinical outcomes should be included as a critical component.

Finding the Best Possible Solution

With the widespread use of healthcare information technology (HIT), data that providers need to track patient care is now readily available.  This is significant, considering that episode of care analysis, where the complexity of measurement is most evident, requires a sophisticated system for tracking and measuring data.

The good news is that episode evaluation systems exist that can span the entire continuum of patient care. Unlike traditional encounter-based systems, these have the capacity to capture all clinically related encounters and assign them to a single episode of illness regardless of care setting, allowing providers and purchasers to accurately compare the total cost and utilization of medical services against local peer groups, national norms and generally accepted best practices. This gives providers the power to measure what matters using meaningful and reliable information for assessing the integrated delivery of cost-effective care.  

Frank Mazza, M.D., chief medical officer, Quantros, is a physician by training (pulmonary, critical care and sleep disorders), and still practices medicine part-time. Prior to joining Quantros, he held several executive positions within the Seton Healthcare Family in Austin, Texas, including system-level chief Patient Safety officer and associate chief medical officer, as well as vice president of Medical Affairs at Seton Medical Center, Austin.