News and Media

Welcome to Quality Buzz. Quality Buzz is dedicated to bringing you all the latest news and information to help you improve the quality of your health care. We update this section weekly and hope that it will become an important resource for you.

June 24, 2010 — Massachusetts Patients Assess Their Experiences With Primary Care

Today we are excited to be sharing the results of a study done by Mass Health Quality Partners.

MHQP is the only independent organization that collects and publicly reports statewide patient experience and clinical  quality performance information about providers in Massachusetts.   

The report released today is a vital element in the success of patient centered care.

Massachusetts Patients Assess Their Experiences with Primary Care in First Comprehensive Survey since State Health Reform Implementation

June 24, 2010

BOSTON — A report released today by Massachusetts Health Quality Partners (MHQP) provides the first comprehensive assessment of how patients rate their experiences with primary care since the state's groundbreaking health reform law was implemented.

Almost 80,000 commercially insured patients responded to the statewide survey and reported overall improvements in several dimensions of the doctor-patient relationship, such as communication and knowledge of their patients, compared to prior MHQP survey results. Similar improvement trends, however, were absent in organizational features of care such as access, and there continue to be important aspects of doctor–patient communications that present opportunities for improvement.

Barbra Rabson, executive director of MHQP emphasized that it is vitally important to understand how health reform is affecting the care that patients are experiencing. "MHQP's survey asks about aspects of the primary care experience that are fundamental to high quality care,"she says. "The survey allows us to understand how patients are experiencing care during this time of great change in our health care system."

James Conway, chair of the Partnership for Healthcare Excellence and Senior Fellow at the Institute for Healthcare Improvement says that MHQP's patient experience survey results also empower patients and families with information on what they should expect in a patient-centered environment. "When patients understand what to expect from their care, they are able to engage and take an active role. The quality of care and the patient experience improve when patients are engaged,"he states.

There is broad agreement that there are important dimensions of care that patients and their families should expect to receive from their primary care practice. Key findings in MHQP's latest patient experience survey highlight where there continues to be room for improvement in these aspects of care, including:

• Knowledge of the patient: When asked if their primary care physician seemed to know their medical history and to know them as a person, both adults and the parents of pediatric patients reported improvements compared with 2007; but 30 percent of adult patients and 25 percent of parents say their primary care physicians do not always know important medical history information.
• Informed of test results: The survey found that about 30 percent of adult and pediatric patients did not always receive follow-up reports on test results from their doctor's office, unchanged from 2007.
• Coordination between primary care doctors and specialists: About 40 percent of adult patients and 35 percent of parents of pediatric patients reported that their physician did not always seem well-informed about the care they received from specialists to whom they had been referred. Pediatric results were slightly better than two years ago, while adult ratings were unchanged.

"These results reflect the ongoing challenges primary care physicians face working within the current fragmented health care system," according to Alice Coombs, M.D., president of the Massachusetts Medical Society. "The good news is that so many physician practices in Massachusetts are performing very well in a less-than-ideal health care system and meeting their patients' expectations for excellent, patient-centered care."

Results drive physician groups' improvement initiatives

Each of the physician offices whose patients participated in the MHQP survey is provided with detailed information on its own scores, so they can compare themselves with their peers and use the data to focus on quality improvement efforts. When Dr. Lester Hartman, the medical director at Westwood-Mansfield Pediatric Associates, reviewed his group's MHQP patient experience survey results two years ago, his initial reaction was disbelief. "We thought we were doing much better than the data indicated,"he says, "so we conducted our own email survey of a thousand parents of our pediatric patients."The results, Hartman says, were "humbling,"because MHQP's report was right on the mark.

Since that time, the physicians and nurse practitioners at Westwood-Mansfield have worked with the practice's administrator and other staff to make systematic improvements in many areas, including communication with patients and parents; appointment scheduling and patient flow; urgent care access; lab test tracking and reporting; health promotion and education; and using MHQP data to gauge their progress. So far, the results are impressive: patients have reported improvements across the board, especially in communication, knowledge of the patient, integration of care, and willingness to recommend the practice.

Framingham Pediatrics is another practice that is using MHQP data to improve their performance and monitor their progress. "We've learned a lot about how to use the data to identify areas for improvement and prioritization,"says Dr. Nancy Rosselot, a pediatrician with the practice. To help optimize the patient experience, the practice created a new position – Medical Home Coordinator – with responsibilities for ensuring coordination and continuity of care, especially when a patient is referred to a specialist outside the practice or has an emergency room visit. In the case of a referral, for instance, the Medical Home Coordinator facilitates the appointment, makes sure the specialist's notes get to the patient's pediatrician after the visit, and tracks any test results to ensure that they are reported to the pediatrician and the patient or parents.

Framingham Pediatrics performs consistently high across all of the dimensions of care measured by the patient experience survey and is looked to as a model for how other practices can be more patient-centered; including by Westwood-Mansfield Pediatric Associates. And, Drs. Hartman and Rosselot agree that improving the patient experience is not only a point of pride for the doctors, nurses and other staff, but that it creates a more positive and satisfying work environment by allowing clinicians to do what they were trained to do – improve the health and well-being of their patients.

About the Patient Experience Survey

The results of MHQP's latest biennial, statewide survey, Quality Insights: Patient Experiences in Primary Care, are online at mhqp.org. Visitors to the site can compare ratings for almost 500 adult and pediatric primary care practices statewide and also find simple action steps for how patients, doctors, and doctors' offices, can all help improve the patient experience.

These results summarize responses from more than 56,000 adult patients and 22,000 parents of children who completed MHQP's Patient Experience Survey in the fall of 2009. Patients who were sent surveys were enrolled in a commercial health insurance program with one of the following health plans: Blue Cross Blue Shield of Massachusetts, Fallon Community Health Plan, Harvard Pilgrim Health Care, Health New England, and Tufts Health Plan.

About MHQP

Massachusetts Health Quality Partners is an independent, not-for-profit organization established in 1995 by a group of Massachusetts health care leaders who identified the importance of using valid, comparable quality measures as a way to drive improvement. Its membership reflects a broad-based coalition of stakeholders working together to promote improvement in the quality of health care services in Massachusetts.

MHQP manages the Greater Boston Quality Coalition's Aligning Forces for Quality Initiative, part of the Robert Wood Johnson Foundation's signature effort to help lift the overall quality of health care across the country. Greater Boston joins 16 other communities, in which health care performance measurement and public reporting are cornerstones to achieving high quality, patient-centered care that is equitable and affordable.

Additional information about Quality Insights: Patient Experiences in Primary Care

MHQP is the only independent organization that collects and publicly reports statewide patient experience and clinical quality performance information about providers in Massachusetts. The 2010 Patient Experiences in Primary Care report follows closely the release of MHQP's sixth annual Quality Insights: Clinical Quality in Primary Care report, which is also available at mhqp.org. Taken together, the two Web-based reports give Massachusetts consumers unprecedented tools for comparing the performance of primary care medical practices.

The MHQP report is based on what patients say about their actual experiences with their primary care physicians, including:

• how well doctors listen to and communicate with their patients,
• how well doctors know their patients' medical history, values and beliefs,
• how well doctors coordinate their patients' care with specialists,
• how well doctors provide preventive care and advice, and
• whether patients would recommend their personal doctors to family and friends.

The report also assesses how well physicians' offices handle patients' access, service and care needs, such as:

• whether patients feel they get timely appointments, care and information,
• whether patients can see their own doctors when they need an appointment,
• how well other clinicians in the practice cared for them, and
• what level of service they get from office staff.

MHQP's first statewide survey of patients' experiences with primary care physicians was released in March 2006.

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May 06, 2010 — The Assertive Patient

Please visit www.assertivepatient.org today.

Now, more than ever, the voices and experiences of patients and their families are being sought after. The Assertive Patient site is a place where patients can give voice to their experiences in a way that will heard and become part of the health care quality discussion.

We encourage you to visit this new site and share it with anyone you feel will benefit.

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April 02, 2010 — National Healthcare Decisions Day

Alert!  Friday, April 16 is National Healthcare Decisions Day. 

The focus for this day is to encourage people to make their end of life wishes known by simply filling out a health care proxy and having a conversation with family and their doctor.

We all know that these types of ‘days’ appear all over the calendar and generally miss the collective conscience.  But today I want to get your attention and ask that you take one minute to understand that your participation in this particular day can have a profound effect on the lives of many people.

Simply by visiting this website - http://www.nationalhealthcaredecisionsday.org/   - you can download posters and proxy forms that may be customized with your logo. By making these materials available in your office and among your clients, customers and community, you will help educate others about the difference having a health care proxy in place can make for the care of a loved one.

Most often, at the end of life, the patient is not able to use their voice and so they are not able to participate in their own care.  This means the patient’s wishes are being determined by any number of family members, doctors, healthcare workers and colleagues.  The time, stress, money and energy expended by so many at the end of a person’s life can take a lasting toll on the family and the entire healthcare system.  This is particularly troubling because end of life is the moment when the focus should be on the life of the patient.

The human and systems costs will be dramatically diminished when each of us states our wishes through a health care proxy and makes clear to our family, friend and doctors what we want.

Health care proxies have only recently made their way into the consumer conversation.  The idea that each of us may, and must, make clear our desires for end of life, is really just beginning to take hold.  One initiative that has been tested in Worcester has met with great success.  Next week, when they launch their website, we will share more information about Massachusetts Medical Orders for Life-Sustaining Treatment (MOLST).

As the people of the Commonwealth strive to understand what healthcare reform means for them, the Partnership for Healthcare Excellence will continue to look for simple and concrete ways for consumers to be more engaged in the process. 

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March 04, 2010 — It’s All About You

From the Desk of Martha Hayward...

Since I took on the role of Executive Director of the Partnership for Healthcare Excellence a month ago, it has become very clear to me that my work is all about you.

The Partnership has made a strong statement of commitment to finding fresh approaches to consumer engagement by putting a consumer advocate at its helm. In my new role, I am dedicated to working collaboratively to provide and disseminate tools to increase consumer understanding of the essential role we play in safety, cost containment and decision-making.

One essential resource is our website, which has been re-designed and recently re-launched. The new design reflects our commitment to providing practical resources to consumers — both by reaching those consumers who visit the site themselves and by disseminating our resources through providers, hospitals, employers or community organizations. As always, you can help us get the word out by sharing these important resources — download our materials, customize them and print on your own or request preprinted materials.

For the last year, the Partnership has used the Quality Buzz to raise awareness of key consumer engagement issues, both locally and nationally. As I embark on my new role, I ask for your help. What topics would you like to see raised through Quality Buzz? Are there relevant things you are involved in that we can highlight through the Buzz? Please contact me by email if you would like to open a conversation about ways that the Partnership might be helpful in reaching your goals for consumer engagement.

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January 26, 2010 — What Are The Best Websites to Compare Facilities and Providers?

A shout out this week for the Informed Patient Institute. The IPI, as it is known, is a non-profit organization that is concerned about the quality of information available to consumers about health care quality and patient safety.

The IPI's website rates literally hundreds of websites that provide background, performance measures, or report cards on different types of health care facilities and professionals. The IPI staff rates each site based on criteria covering six areas – site content, timeliness, presentation, ease of use, information to make decisions and special features. Websites are assigned grades from A ("outstanding") to F ("not worth your time"). Equally useful are the comments made by IPI staff about each website. IPI promises to update its ratings annually.

IPI has an ambitious plan to rate on-line report cards for many other types of facilities and professionals, including urgent care centers, psychologists, etc. However, at the moment, it is limited to nursing homes and physicians.

The IPI website is among the new resources included on the Partnership's new website. Look for it to launch later this week. In our next Quality Buzz, we will give a tour of the exciting features available on our new site.

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January 12, 2010 — High Tech and High Touch Care

Can large academic medical centers provide the personalized and compassionate care valued by patients and their families?

This is the question posed in a recent op-ed by Douglas Brown of UMass Memorial Health Care. He notes that Clinton Hospital, the smallest hospital of the UMass Memorial Health Care system, outperforms UMass Memorial Medical Center, the academic medical center that serves as the flagship of the system, when it comes to patient satisfaction scores. Mr. Brown notes that the Medical Center treats patients who are sicker and require more complex care than Clinton and then asks why teaching hospitals aren't satisfying patients as well as Clinton.

Complex care typically requires larger teams of medical professionals – specialists, sub-specialists, various therapists, nurses, etc. Patient rooms are often crowded with equipment. Nonetheless there are academic medical centers that do achieve high patient satisfaction ratings.

Some of them are affiliated with an international non-profit organization called Planetree. Planetree was founded by a patient who had a very bad experience at a California teaching hospital. Planetree promotes the development and implementation of innovative models of health care that focus on healing and nurturing body, mind and spirit. Planetree focuses on everything from the design of facilities to the nature of the patient-caregiver relationship.

Planetree is not the only organization promoting patient centered care. However, Planetree is among the few that explicitly addresses how the design of space and the environment impacts patient experience.

Kudos to UMass Medical Center for joining Berkshire Medical Center in Pittsfield and Martha's Vineyard Hospital for adopting the Planetree model.

Hopefully, UMass Medical Center will soon rival Clinton Hospital on its patient satisfaction scores!
 

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December 22, 2009 — An Important Milestone in Patient Safety

This month marks the tenth anniversary of the release of "To Err is Human" by the Institute of Medicine (IOM). The report, which documented that medical errors were a pervasive problem across the US, generated widespread media attention and launched the modern patient-safety movement.

In marking the anniversary, several leaders in the patient safety movement have published progress reports, summarizing progress to date and challenges that lie ahead. While significant progress has been made, there is consensus that we have fallen short of goals set a decade ago.

The Partnership's Chairman Jim Conway recently joined with other members of the Lucian Leape Institute of the National Patient Safety Foundation to summarize what it would take not to simply implement recommendations established by the IOM, but to transform the health care system to achieve meaningful improvement in safety. The transforming principles include:

• Transparency – free sharing of information including sharing information with patients, including information on when things go wrong.
• Integrated care - that is patient-centered.
• Consumer engagement – as summarized by "nothing about me without me."

While there has been progress, we have a long way to go. Since our launch in 2007, the Partnership has worked to increase consumer awareness of the simple steps, such as writing down questions for the doctor, that all of us can do to increase our level of engagement in our health care. In the course of our work, we have learned that we cannot do it alone. We are grateful for the support of our Leadership Council and our partners in helping us reach literally hundreds of thousands of consumers. We look forward to continuing our campaign in 2010. Happy Holidays from the Partnership.

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December 15, 2009 — Making a List and Checking it Twice

Many of us will take to the roads and skies for the holidays. Between packing suitcases and wrapping presents, medications can sometimes take a back seat to the fruitcake. Here are some tips to make sure you are safe during your holiday travels:

• Bring an up-to-date medication safety list with you. It can save your life in case of an emergency. It gives medical personal the information they need to know to treat you in the event you can't speak for yourself. If you are traveling, it's unlikely that an emergency room will be able to access your medical record – even if it's computerized at your "home" hospital.
• Resist the urge to combine your medications into one bottle or bag. Keep them in their original bottles.
• Put your medications in your carry-on bag (and pull them out if the airline crew decides just before take-off that your carry on can't fit on board).
• If you forget pills that you must take daily, call the local pharmacy. Stores in national chains can generally access your pharmacy records on line. Pharmacists can also call your doctor's office.

Wishing everyone a happy and safe holiday season.

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December 08, 2009 — A “Game Changing” Website

Check out http://www.patientopinion.com/. It invites patients to post their wisdom and insights about the National Health Service in the United Kingdom. As the site says, "this is our National Health Service, let's make it better." Since it launched in 2006, the website has recorded and indexed close to 18,000 comments. Consumers can easily search to find all comments posted about a particular hospital. What's most amazing is that the people behind the website send the comments to the hospitals involved and the hospitals are given an opportunity to respond. The site points to several instances where comments have contributed to positive changes. Here in the US, we have report cards on hospital performance. Patients share comments on bulletin boards sponsored by support groups. However, we don't have anything like Patient Opinion... yet. It would a real "game changer" if we did.

A 50:50 Chance of Infection
An international study of patients in Intensive Care Units (ICU) revealed that ICU patients have a 50:50 chance of having an infection. The study looked at approximately 14,000 patients who were hospitalized on a particular day in 2007. Approximately 51% were classified as having an infection. It found that the longer patients stayed in the ICU, the more likely they were to have an infection. People who had infections in the ICU were more likely to die than patients who did not have infections. Infection rates in North America were slightly below the international average.

This is yet another reminder of the importance of working with your health care team to reduce your risk of getting a dangerous infection in the hospital. For simple steps you and your family can take, visit our website.
 

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December 01, 2009 — Treatment Guidelines and Me

The flurry of debate regarding the new breast cancer screening guidelines released by the US Preventive Services Task Force is leaving many consumers – including me – confused.

Do I continue to get an annual mammogram? What's the evidence for and against? What are the benefits and risks? By the way, I don't have a degree in biostatistics or epidemiology, so please remind me what a "false positive" is and why it is that bad – for me? (Emphasis here on "for me" and not on "for society.")

We should keep this debate on breast cancer screening in mind as we think about health care reform. Most health care reform proposals include a provision for evaluating the comparative effectiveness of alternative medical treatment. This Comparative Effectiveness Research would be shared with consumers and physicians (and other practitioners) to make informed decisions.

Communicating the evidence from Comparative Effective Research will be difficult. However, patient education tools (also called decision aids) can help. At the end of the day, however, it will be up to the patient and his/her own physician to work together to make appropriate decisions.

In the meantime, my list of questions for my next doctor's appointment just got a little longer.

Last night, AARP Massachusetts and the Partnership were at Salem State College for the last in our series "The Crisis in Health Care: What's A Patient To Do?" Many thanks to Salem State for hosting and its President Patricia Maguire Meservey for moderating the panel.

L-R: Martha Page, North Shore Medical Center, Marilyn Schlein Kramer, Partnership for Healthcare Excellence, Martha Hayward, Women’s Health Exchange, Mitchell Rein, North Shore Medical Center, Patricia Maguire Meservey, Salem State College

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