November’s issue of Health Affairs featured work from AcademyHealth members on how to improve patient safety and the best ways to reduce hospital costs and liability, among other topics.
Improving Patient Safety
One key issue in improving patient safety is the streamlining of safety data reporting. Reporting can often be limited or unreliable, as a research team in San Francisco found in their study of the California pay-for-performance program. To make reporting easier, researchers are developing new technologies. AcademyHealth member David Classen, M.D., M.S., chief medical information officer at Pascale Metrics, worked with colleagues to develop a patient safety active management (PSAM) system that analyzes electronic health records to identify, classify, and measure patient safety on a large scale. It allows health care professionals to detect harm in real time, at higher levels than before, and predict future safety issues.
Other studies in the issue suggested new areas of improvement for patient safety. Linda Aiken, Ph.D., FAAN, FRCN, R.N., a nurse researcher and professor at the University of Pennsylvania, worked with fellow AcademyHealth members to study the tie between nurse work environments and patient safety. They found that hospitals with better nurse work environments were more highly rated and recommended by patients, with nurses reporting higher “quality of care” for patients. AcademyHealth members also researched new ways to improve surgical safety. Research from the Safe Surgery South Carolina Program found that using the World Health Organization Surgical Safety Checklist improved patient safety. However, introducing the checklist required time, resources, and combination of high and low-touch approaches.
Studies in the November issue also dealt with patient safety in new contexts. AcademyHealth members co-authored a study of patient safety in nursing homes examining recent health policy efforts to make safety data publically available on the National Nursing Home Compare website. However, they found that safety data on the website was inadequate and often conflicting, concluding that the disparity “highlight[s] the differences between patient safety and quality improvement, two related but distinct approaches to improving health care.” the authors recommended refining criteria and reporting methods.
Finally, AcademyHealth members at Brandeis University, Ph.D. student Morgan Shields and behavioral health professor Maureen Stewart, Ph.D., found that patient safety in psychiatry needs more research, regulations, and monitoring, calling it a “new frontier” for health policy. While Shawna Smith, M.Phil., Ph.D., and fellow AcademyHealth members studied innovative ways to use data collection and monitoring to improve patient safety in hospitals.
Reducing Hospital Costs and Liability
Several studies in last month’s issue looked at improving hospital operations, lowering costs, and reducing liability. One costly issue for many hospitals is diagnostic error, which can lead to malpractice claims. A study co-authored by AcademyHealth member and Urban Institute Fellow Robert Berenson, M.D., found that Alternative Payment Methods (APM) can reduce diagnostic error and related costs. APMs based around quality of care and accuracy can incentivize physicians to make more accurate diagnoses, reducing the risk of malpractice claims.
However, when malpractice claims do occur, one emerging response is communication-and-resolution programs (CRPs). CRPs encourage transparency, taking responsibility, and proactive compensation. While there were concerns about if the CRP approach raises hospital liability, AcademyHealth member Michelle Mello, J.D., Ph.D., of Stanford University and colleagues found that CRP can be implemented without adverse financial consequences. While the CRP approach has been broadly adopted by the field, some questions remain. A follow-up study of CRPs found that five key issues are: implementation, the link between CRPs and patient safety, fair compensation to patients, aligning programs with patient needs, and public policy related to CRPs. Authors suggested additional research on these issues, but still encouraged CRPs, calling the method a “revitalization of the medical profession” and a way to improve transparency and patient empowerment.
New Perspectives on Health Care
Health Affairs also published a thought-provoking article about the hidden rise of maternal mortality in the US. Tracing the impact of maternal mortality in her own family, University of Minnesota public health professor and AcademyHealth member Katy Kozhimannil, Ph.D., M.P.A., suggests establishing a national maternal mortality review committee, improving access to care and insurance coverage, recognizing and countering unconscious bias and racism in health care, holding clinicians accountable for their diagnoses, and actively listening to women’s concerns and questions. She encourages the field take action to “ensure that for our daughters and granddaughters every birth is sacred and safe.”
Beyond these main themes, AcademyHealth members published on a wide range of other health care issues. AcademyHealth member Margaret Smith, M.D., collaborated with colleagues at the University of Michigan on a study of how improving interpersonal and organizational dynamics also improved postoperative patient outcomes. Other AcademyHealth members researched changes in health premiums in 2018.
The November issue of Health Affairs brought together a wide range of research and opinions centered around patient safety, hospital operation, and emerging health trends and issues. Congratulations to the AcademyHealth members who contributed to these critical studies bringing new evidence to improve health and health care.