October 15, 2015
In order to bring you more of the news you want to read, RightCare Weekly summarizes and interprets three important articles and provides headlines linking to the many other articles and editorials you’ll find interesting. As always, RightCare Weekly presents articles related to moving our healthcare system toward the right care for all patients.
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Defining and measuring quality in healthcare has long been a goal and a significant quagmire in healthcare reform. CMS has committed to making 50 percent of Medicare payments tied to quality metrics by 2018 but, as Aaron Carroll, MD, MS, explains in this JAMA Forum, that presumes we are good at measuring quality. Unfortunately this is quite far from the truth. In an open letter to the American public, members of the RightCare Alliance’s Primary Care Council bring this issue to the fore. Addressing all patients, the authors write that current metrics do not allow “us to work with you to determine what matters most to you in your care nor to help you adopt healthy behaviors that improve your quality of life. Many of the current ‘quality’ measures distract your healthcare professional from giving you the care you need.” They explain that better quality metrics could improve access and shared decision-making, and they invite patients to work with them to improve the way we measure doctors’ performance. If you are a physician or other healthcare professional and agree with this message, please sign the letter here. If you haven’t yet found an action for RightCare Action Week, this could be it!
A recent study by Lisa A. Wolf, PhD, RN, CEN, FAEN, et al. probed the experience and causes of moral distress in emergency nursing. Participants described moral distress as an “inability to perform the obligations of nursing at the social justice level” and identify its causes as being “directly related to a lack of unit support, an overemphasis on technology to the exclusion of patient interaction, and the perception of a distinct disconnection between the administrators and the practitioners delivering care.” This investigation revealed themes of a dysfunctional practice arena, nurses being overwhelmed, adaptive/maladaptive coping, and overall, a profound feeling of being unable to provide patient care as they wanted to. Specific environmental factors contributing to moral distress included excessive documentation and a focus on time-based metrics, inadequate or unsafe staffing, and patients, often poor or homeless, who are frequent utilizers of the emergency department. The authors conclude that moral distress in emergency nursing is the result of a high-demand environment with insufficient resources, and that interventions are needed at the systems-level, and require the support of hospital administrators.
Last week we told you about the online antibiotic stewardship PLEDGE, developed by the Pediatric Council of the Lown Institute to encourage more responsible prescribing to children and reduce the widespread overuse of antibiotics. The pledge is just one of the activities planned by the Council for RightCare Action Week, next week. Council members, Shawn Ralston, MD and Alan Schroeder, MD, who spearheaded the pledge, encourage others to sign the document in a Medscape piece. Coincidentally, in its current issue, Parents Magazine chose a cover piece on pediatric antibiotic use and misuse.
Cost of care
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Care delivery models
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