Don’t deny the poor their dignity, IT is no substitute for a safe culture, and does the AQC really pay for quality?
April 9, 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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When Jeanine Grant Lister buys groceries, she uses her EBT card (food stamps). She buys what is needed, but proposed legislation in some states may soon dictate what food she and other recipients can buy, and foods like cookies, energy drinks and seafood may be out. The impulse to use the food stamp program to improve nutrition is understandable, but this mechanism is troubling: In a Washington Post opinion piece, Grant Lister writes that “…Being poor is tantamount to a criminal offense […] one that costs you a number of rights and untold dignities, including, apparently the ability to determine what foods you can put on the dinner table.” Resorting to punitive measures to influence people’s behavior not only risks undermining people’s dignity, but may also reduce the effectiveness of social support programs. There are less punitive options. PBS NewsHour profiled Judy Puglisi, a principal at one Connecticut school, who called into the question the “zero tolerance” school discipline system. She recognized that many students who act out have a history of trauma at home. Instead of punishing student bad behavior, she enlisted the help of a trauma response program that aids at risk students. By responding to individual student needs with dignity – instead of the blanket punishment approach – behavior problems dropped in her school, which in turn led to fewer suspensions and a higher graduation rate.
In a remarkable series of excerpts from his book, Bob Wachter, MD tells the story of a massive antibiotic overdose given to a patient at UCSF. Because of a series of failures, both in human action and in the design of information systems within the hospital, the patient received nearly 39 times the intended dose of a medication he’d been taking for years. While computerized drug ordering and other clinical IT systems have prevented many harmful errors in recent years, serious safety problems remain, including “alarm fatigue” and insufficient communication among clinicians. Most importantly, though, IT can’t improve patient safety on its own. To protect patients, technology needs to be integrated with, and reinforce, a culture of patient safety.
Now that momentum appears to be growing to move Medicare’s payment system away from fee-for-service, more attention is being paid to Massachusetts Blue Cross Blue Shield’s Alternative Quality Contract, which pays physicians and hospitals in the state in part based on their performance on a set of quality metrics. While that is common for pay-for-performance contracts, many doctors are critical of the particular metrics BCBS uses. RightCare Alliance member Steve Martin, MD, is quoted several times in a recent Medpage Today story, pointing out that many metrics are out-of-date, based on faulty studies, have little relevance for patients, or encourage doctors to game the system. In addition, many specialty society guideline panels are heavily conflicted, leading critics to worry that metrics based on those guidelines will be biased and lead to poor care.
Save the Date! Thursday,April 16, 1-2 pmET. Join us for a webinar on the Do No Harm Project, a special session for clinicians and trainees to learn how to implement this program in your institution. Presenters are the program founders, Brandon Combs, MD, FACP, University of Colorado School of Medicine and Tanner Caverly, MD, MPH, University of Michigan. The DNH Project inspired the Teachable Moments series in JAMA Internal Medicine. Register now.
Have you signed up for RightCare Action Week? It’s the week starting October 18, when clinicians will take action to raise awareness of what is wrong with our healthcare system and showing our colleagues and our patients how much better things could be. Sign up now and tell us what you want to focus on during that week.