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  • Why Not The Best
    Murphy D M Needham C Goeschel et al American Journal of Medical Quality Vol 25 No 4 255 260 2010 View Publication Costs Attributable to Healthcare Acquired Infection in Hospitalized Adults and a Comparison of Economic Methods R R Roberts R D Scott B Hota et al Medical Care November 2010 48 11 1026 35 View Publication Do Patient Safety Events Increase Readmissions B Friedman W Encinosa H J Jiang et al Medical Care May 2009 47 5 583 90 View Publication Effect of a Comprehensive Surgical Safety System on Patient Outcomes E N de Vries H A Prins INITIAL Rogier et al New England Journal of Medicine November 2010 363 20 1928 37 View Publication Effect of Bar Code Technology on the Safety of Medication Administration E G Poon C A Keohane C S Yoon et al New England Journal of Medicine May 2010 362 18 1698 1707 View Publication Fall Prevention in Acute Care Hospitals A Randomized Trial P C Dykes D L Carroll A Hurley et al Journal of the American Medical Association November 2010 304 17 1912 8 View Publication First State Specific Healthcare Associated Infections Summary Data Report National Healthcare Safety Network NHSN January June 2009 Centers for Disease Control and Prevention View Publication Impact of the Comprehensive Unit Based Safety Program CUSP on Safety Culture in a Surgical Inpatient Unit J Timmel P S Kent C G Holzmueller et al Joint Commission Journal on Quality and Patient Safety Volume 36 Number 6 June 2010 pp 252 260 9 View Publication Improving safety culture on adult medical units through multidisciplinary teamwork and communication interventions the TOPS Project M A Blegen N L Sehgal B K Alldredge et al Qual Saf Health Care Aug 2010 19 4 346 50 View Publication Intensive care unit safety culture

    Original URL path: http://www.whynotthebest.org/contents/index/5/11 (2016-04-30)
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  • Why Not The Best
    saved reports Log In Register Reports Map Improvement Tools Resources Methodology About Case Studies Improvement Tools Related Publications All Series Heart Attack Care Heart Failure Care Pneumonia Care Surgical Care Improvement Patient Experiences Overall Health Care Quality Readmission Rates Mortality Rates Reimbursement Patient Safety Reducing Infections Public Hospital Commentaries How to Use This Site Related Publications Selected publications from research organizations and the professional literature related to performance measurement and

    Original URL path: http://www.whynotthebest.org/contents/index/5/12 (2016-04-30)
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  • Why Not The Best
    Evaluation of All Participating Hospitals B L Hall B H Hamilton K Richards et al Annals of Surgery September 2009 250 3 363 176 View Publication Does Teamwork Improve Performance in the Operating Room A Multilevel Evaluation S J Weaver M A Rosen D DiazGranados et al Joint Commission Journal on Quality and Patient Safety March 2010 36 3 132 42 View Publication Effect of a Comprehensive Surgical Safety System on Patient Outcomes E N de Vries H A Prins INITIAL Rogier et al New England Journal of Medicine November 2010 363 20 1928 37 View Publication Effect of Bar Code Technology on the Safety of Medication Administration E G Poon C A Keohane C S Yoon et al New England Journal of Medicine May 2010 362 18 1698 1707 View Publication Effectiveness of Public Report Cards for Improving the Quality of Cardiac Care J V Tu L R Donovan D S Lee et al JAMA Vol 302 No 21 Pages 2330 37 December 2009 View Publication Emergency Department Operations in Top Performing Safety Net Hospitals L Nolan M Regenstein et al The Commonwealth Fund July 2009 View Publication Estimating a Composite Measure of Hospital Quality from the Hospital Compare Database Differences When Using a Bayesian Hierarchical Latent Variable Model Versus Denominator Based Weights M Shwartz J Ren E A Peköz et al Medical Care August 2008 46 8 778 85 View Publication Fall Prevention in Acute Care Hospitals A Randomized Trial P C Dykes D L Carroll A Hurley et al Journal of the American Medical Association November 2010 304 17 1912 8 View Publication First State Specific Healthcare Associated Infections Summary Data Report National Healthcare Safety Network NHSN January June 2009 Centers for Disease Control and Prevention View Publication Groups Try Simple Steps to Avoid Hospital Rebound CBS

    Original URL path: http://www.whynotthebest.org/contents/index/5/page:2 (2016-04-30)
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  • Why Not The Best
    All Series Overall Health Care Quality Readmission Rates How to Use This Site Commentaries Invited commentaries on subjects related to performance measurement and improvement Commentary Transparency and Public Reporting Are Essential for a Safe Health Care System Lucian L Leape M D asks What will it take to motivate hospitals to do what we know works to make health care safer Of the three major approaches to improving patient safety

    Original URL path: http://www.whynotthebest.org/contents/index/4/6 (2016-04-30)
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  • Why Not The Best
    to a modern browser Access your saved reports Log In Register Reports Map Improvement Tools Resources Methodology About Case Studies Improvement Tools Related Publications Commentaries All Series Overall Health Care Quality Readmission Rates How to Use This Site Commentaries Invited commentaries on subjects related to performance measurement and improvement Commentary Understanding CMS Readmission Data and Putting it to Use for Quality Improvement Stephen F Jencks M D M P H

    Original URL path: http://www.whynotthebest.org/contents/index/4/7 (2016-04-30)
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  • Why Not The Best
    significant patient harms that hospitals know how to prevent or should know Such financial disincentives began in Minnesota but have been given national reach with CMS recent decision not to reimburse hospitals for the additional costs attributable to eight serious reportable events Although the stakes for any hospital are small these are or should be rare events the pushback has been considerable Hospitals claim with some justification that not all of these events are preventable This concern seems particularly apt for at least two of the no pay events on the CMS list falls and urinary catheter associated infections 6 Reliable and valid practices for preventing these adverse events have yet to be developed Evidence that not paying for serious reportable events improves safety also is lacking The experience in Minnesota is not encouraging For example the number of wrong site surgeries and retention of foreign bodies in Minnesota hospitals actually increased substantially from 2006 to 2009 7 Some of this increase is undoubtedly related to improved compliance with the reporting requirement but nonetheless it does not indicate that the penalty is having a positive effect Reporting and Feedback So far the most powerful method for reducing preventable injuries has been to require physicians to provide data on their own performance and then provide them with comparisons of their risk adjusted complication rates with those of their peers The Veterans Administration VA pioneered this approach in the 1990s with its National Surgical Quality Improvement Program which has since been adopted and promoted by the American College of Surgeons Under this program each hospital s surgical specialty department receives feedback on its risk adjusted complication and mortality rates together with a comparison with all of the other unidentified surgical departments in the VA system In response to these reports below average units made substantial improvements leading over several years to systemwide declines in both complication rates and mortality that significantly exceeded the secular trend 8 It is reasonable to assume though as yet unproved that public reporting of similar types of data would spur hospitals to make greater efforts to reduce adverse events Hospitals or the public can choose the benchmark level they prefer above average top decile or others But it seems evident that performance reporting works best when all providers participate as in the VA experience Thus reporting has to be mandatory As Wachter emphasizes it is essential that the events to be reported are a clinically significant b easily measured and c largely if not completely preventable 9 Risk adjustment is essential for fair comparisons The benchmark in safety of course should be zero If it is then risk adjustment is irrelevant The hope is that as it becomes public knowledge that some hospitals are able to eliminate certain types of adverse events others will be motivated to follow While a major thrust of the patient safety movement has been to eliminate blaming and shaming of individuals when they make mistakes for organizations public reporting may be an

    Original URL path: http://www.whynotthebest.org/contents/view/142 (2016-04-30)
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  • Why Not The Best
    between patients in different hospitals and hence to judge whether the hospital s performance is better or worse than would be expected for patients with similar characteristics This model is quite conservative in that it finds a very large fraction of hospitals to have rates that are neither better nor worse than expected Small hospitals are particularly unlikely to be identified as better or worse Since heart attack heart failure and pneumonia rehospitalization rates are fairly strongly correlated looking at them together may be useful For example if all three rates are appreciably higher than expected something is probably going on even if no individual rate is significantly higher than expected 2 It is also important for hospital leadership to keep in mind that the average rehospitalization rate with which a hospital s performance is compared is generally not very good and being average should not be a source of complacency much less pride It may be helpful to look at hospitals that are significantly above average to see what they are achieving their performance level can be considered a plausible target and perhaps a benchmark 3 The CMS rates reflect data averaged over time and take some time after the data set closes to get published The result is that tracking improvement through this publication will be very difficult and lead to an improvement cycle so long as to be unhelpful 4 Replicating the CMS results is essentially impossible for an individual hospital because it cannot know how many of its patients are rehospitalized elsewhere and it does not have the ambulatory claims data that are needed for the CMS risk adjustment model 5 The data reported here are limited to the outcome of rehospitalization within 30 days They provide no information on processes of care and their adequacy

    Original URL path: http://www.whynotthebest.org/contents/view/112 (2016-04-30)
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  • Why Not The Best
    Resources Methodology About Case Studies Improvement Tools Related Publications Commentaries How to Use This Site Commentaries October 2013 CMS Hospital Compare Update Cancelled Due to the government shutdown the Centers for Medicare and Medicaid Services CMS has announced it will not be refreshing Hospital Compare as planned this month The next scheduled release of the website is set for December 12 2013 At that time CMS will update the readmission

    Original URL path: http://www.whynotthebest.org/contents/view/270 (2016-04-30)
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