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, 2009 — Terry Francona says there are no ‘dumb questions’ for your doctor

Last Tuesday, the Partnership joined Covidien and the Town of Mansfield in hosting a "Strike Out Infection" event to educate the public about ways to prevent the spread of MRSA and other infections. I had the privilege of speaking at the program, along with Boston Red Sox Manager Terry Francona. Terry experienced a serious infection and was in and out of hospitals for several months. As Terry forcefully said, "There are no dumb questions" when talking with your doctor. Check out a segment on the event from WCVB-TV.

Amid the national push to computerize medical records and make them more open to patients, one of the most intense areas of debate is whether patients should be allowed to see their doctors' notes. With funding from the Robert Wood Johnson Foundation, Boston's Beth Israel Deaconess Medical Center is starting a project called "Open Notes." In this project, 25,000 to 35,000 patients will read office visit notes from approximately 100 physicians for a period of one year. Proponents say that getting access to notes could increase patient participation and improve communication between patients and doctors. Others say that it will discourage physicians from being candid in their notes. It will be interesting to learn if giving patients access to doctors' notes will change what physicians write. A question for you to consider - If your doctor's notes were available, would you take the time to read them? What would you be interested in learning?

This week ABC News provides a snapshot of Six Things That Patients Do That Frustrate Their Doctors. At the Partnership, we speak of taking a companion to a physician visit if you think it would be helpful. This article cites research showing that 16% of all patients bring a companion to their doctors' appointments and notes that sometimes companions can interfere with doctor/patient communications. If you bring a companion to visit or serve as a companion to others, keep in mind that the doctor needs to speak directly with the patient. The doctor should assure that both parties – the patient and the companion – understand instructions and the care management plan.

Last week new Massachusetts regulations went into effect that prevent hospitals from billing for preventable "Serious Reportable Events" such as wrong side surgery. This economic penalty coupled with public reporting will hopefully result in far fewer events in the future and improved patient safety in our hospitals. We hope that reporting on quality will soon be extended outside of hospitals to nursing homes, dialysis centers, ambulatory surgery centers and other outpatient settings.
 

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June 15, 2009 — Greater Boston Joins Aligning Forces for Quality

The Partnership is very pleased to be a part of the Greater Boston Aligning Forces for Quality Initiative, which this week has been awarded a grant by the prestigious Robert Wood Johnson Foundation. This six month planning grant will be used to develop a plan of action to better align efforts and effect system change that will impact the way care is provided, received, and paid for in the Greater Boston region. Particular attention will be paid to helping physicians improve the quality of their care and encouraging people to become better partners with their doctors. Several members of the Partnership's Leadership Council are among the 35 organizations coming together to work on this project.

As the New York Times pointed out last week, Twitter and other social media can be a promising way to facilitate patient physician communications and to encourage creation of "virtual support groups," particularly for patients with rare conditions. As one doctor commented "[Social media equals] more time for me and improved communication/access for my patients." However, as others point out there are many issues regarding privacy and physician and patient expectations regarding turnaround time, permissible and appropriate topics for social media, etc.

Last week on All Things Considered, Dr. Elliot Fisher from the Center of Health Policy Research at Dartmouth explains how physicians, hospitals and other providers in some markets like Green Bay Wisconsin are providing care equal or better to higher cost markets. As many have noted in the discussions about health care reform, higher costs are not linked to higher quality. Often absent from this discussion is the role patients have in improving quality of care and helping to reduce costs. Patients who are engaged in their care and participate in treatment planning get better care. As many researchers have shown, when patients share in medical decision making, they often decide to forgo expensive surgery in favor of less expensive treatment. We would hope to see more discussion about the role of the patient in the debate about health care reform.
 

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June 10, 2009 — Rapping Nurses Tackle Handwashing

This week's video shows the benefits of becoming an engaged patient. Robin Polishook of West Newton discusses how her resolve to ask questions and engage with her physician has helped her feel confident and in control of her health. Check out Robin's entire video here.

Robin's video marks the final installment of the Partnership's video series on becoming a "great patient." I hope that you have enjoyed these testimonials. The entire set is available on our website and through YouTube. I encourage you use them as a reference and pass them along to your family and friends.

It seems that every month there are new websites that provide information for consumers to research and rate doctors. Yesterday in "Looking for Dr. Right," The Boston Globe reviewed several of these sites and noted that in many cases ratings were based on limited information. The Partnership recommends that sites disclose their ratings methodologies, like Partnership Leadership Council member MA Health Quality Partners. Our consumer surveys show that Massachusetts consumers are generally unaware of websites that compare physicians. We need to find resources to fund promotion of credible websites to consumers.

The movement for "patient-centered" care is growing among physician practices. Multiple studies have shown that patient-centered practices deliver better care at lower cost by reducing unnecessary services and hospital care.

While media coverage has increased awareness about flu and infection prevention, the challenge has been to motivate and remind patients and health care workers to take preventative actions—such as washing hands—on a regular basis. Listen to a rap song Massachusetts General Hospital nurses created to remind staff to wash their hands. Almost two million patients acquire infections in health care settings each year. Perhaps the humor of the rap song will help address a very serious quality and cost issue for the health care system.

As reported in last week's New York Times, Dr. Donald M. Berwick, the widely respected president for the Institute for Healthcare Improvement, links transformation of the US health care system with the campaign for greater patient engagement. He sees a time when the system would transfer control from doctors to the patients themselves. Dr. Berwick calls himself "an extremist"—we call him "inspiring."
 

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June 02, 2009 — Healthcare Quality—from McAllen, TX to Beverly, MA

Happy June! After a short break for the holiday weekend, the Partnership is proud to present this week's new video as great resource for anyone headed into surgery. Dr. Richard Miller of Southcoast Hospitals Group discusses how communications between patients and doctors can help improve quality of care in the operating room and during recovery. As a practicing surgeon, Dr. Miller advocates that "anytime is the right time" for patients to ask questions. Check out the video to learn how to prepare for surgery.

"The Cost Conundrum" by Dr. Atul Gwande looks at the town of McAllen, TX as a microcosm of the inflation in health care costs in America. The article illustrates how overuse of medical services has led to increased costs for all without measurably improving outcomes. On the other hand, Seattle, WA and Durham, NC have world-class hospitals but costs well below the national average. Once again, it appears that quality care does not have to come at a higher cost. Dr. Gwande suggests that high quality, low cost care is delivered when there is accountability and when the needs of the patient come first.

Yesterday, a nice crowd came to Beverly Library to hear Marilyn Kramer (the Partnership's Executive Director) and State Representative Mary Grant (D-Beverly) speak on "The Crisis in Healthcare Quality: What is a Consumer to Do?" During the lively discussion that followed, audience members spoke about payment reforms needed to provide better coordinated care. Our thanks to Mary Grant, a nurse by profession, for helping us get the word out to consumers in Beverly.

And finally, on June 16th, Marilyn Kramer, Red Sox Manager Terry Francona and others will be speaking at an event hosted by Covidien on preventing infection in schools, hospitals and the community. Come learn how to help Strike Out Infection!
 

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May 19, 2009 — “Patient Dave” Says It Best

This week's video illustrates the meaning of being an engaged patient. Cindy Skowyra of Brimfield, MA tells us about her experience with a painful infection and the importance of asking her doctor questions and seeking a second opinion. Her account shows us all that working in partnership with your medical team can make a big difference. To view Cindy's story, click here.

There's another website being promoted as a tool for consumers to find high quality doctors. This new database created for USA Today includes 6,000 specialists practicing in more than 300 metropolitan areas nationwide. For each community, the website lists the top 3-5 physicians based on how much they influence their peers. The website developers make this assessment based on the number of articles/research studies published, referral patterns, etc. At this point, the database only includes specialists treating a few conditions (diabetes, high cholesterol, high blood pressure and asthma), but they hope to add more. We would be curious to learn if you found this resource to be helpful.

The MA Public Health Council passed several new rules this week to improve patient safety in Massachusetts hospitals. Under the new rules, hospitals must create Patient and Family Advisory Councils by October 2010 and submit plans for establishing them by this September. When implemented well, these councils are an important element in a culture of patient-centered care. It's probably too early to call your hospital and volunteer, but you may want to inquire about their plans after September and see how you can get involved.

Finally, e-patient Dave, the "champion of participatory medicine" was interviewed in Monday's Boston Globe. As he says, "Some people who advocate for healthcare reform are driven by a bad experience that they had. I had a terrific experience. What drives me is a vision for what will be possible when we patients help our doctors by taking a more active role in our care. 'Patient' is not a third-person word. This is personal. Whether it's you, yourself, or your spouse, your mother, your child, there is a health crisis in your future. And when it hits, you want healthcare systems to work better than they do today."

We couldn't say it better. Yeah, Dave!!!
 

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May 12, 2009 — New tool: Create your own list of questions

This week's Partnership video focuses on ways to prevent infection. Dr. Ronald Goodspeed, President of the Massachusetts Coalition for the Prevention of Medical Errors, explains that there are several simple ways that you and your loved ones can stay safe from infection. The easiest is washing your hands, and making sure that all members of your health care team do the same. Learn more of his tips by clicking here to watch the video and checking out the Partnership's fact sheet on how to prevent infection. It can be hard to remind a busy nurse or physician to wash their hands, but it is a tremendously important preventive step.

The federal government agency responsible for improving the quality, safety, efficiency, and effectiveness of health care launched a new campaign to encourage Americans to ask questions of their health care providers. The campaign includes a series of light-hearted public service announcements which play on the fact that people who are normally confident and well-spoken can clam up in their doctor's office. The campaign features a website that lets consumers create and print a set of personalized questions to bring to medical appointments.

Last week in an op-ed in the Boston Globe, Ellen Goodman continued a public discussion on end of life care that has included President Obama. As Ms. Goodman noted, close to 80 percent of elderly Americans are spending their final days in a hospital, yet the majority would rather pass away "peacefully" at home. She argues that more expensive care may not be better care. On the other hand, Mr. Obama told a New York Times reporter how he would have personally paid for his grandmother's hip replacement surgery even if it meant improving her quality of life for what proved to be only a few more days of life. This public dialog provides a poignant reminder of personal discussions we should be having with our loved ones.
 

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May 04, 2009 — A Mother Talks About MRSA

While little is known about how serious or how widespread Swine Flu or H1N1 could become, we are reminded that the best prescription for prevention is common sense. As President Obama and USA Today remind us, simple steps, such as handwashing, can make all the difference.

Today, the Partnership is releasing our fifth video, in which Maria Grungo of Dartmouth, MA discusses her son's experience with a serious infection. Drawing from her experience both as a mother and a nurse, she describes changes her son and the rest of her family have made to protect themselves from future infections. We can all learn from her compelling story – take a look.

Oprah recently focused on the risk of MRSA (i.e. staph infection). According to Dr. Mehmet Oz, a regular Oprah contributor, the rate of MRSA infections is on the rise and athletes are at higher risk than the rest of the community. He noted that 33 professional football players have been infected by MRSA since 2006. This serves as a good reminder for parents of Little Leaguers and other young athletes to teach children about what they can do to reduce the risk of infections.

In other news, researchers at Brigham and Women's Hospital and Massachusetts General Hospital in Boston have found that the use of an integrated computer system can reduce the number of potential medication errors.

Finally, to mark Women's National Health Week, the Partnership is sponsoring a National Check Up event on May 11th at the YWCA in Worcester (One Salem Square) from 4-7 PM. Medical experts from Women's Health of Central Massachusetts will be available for individual consultations about preparing for doctor's visits and to conduct blood pressure screenings. Please tell your friends and family about this free event.
 

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April 28, 2009 — Not My Doctor: Poll on Overuse

This week, the Partnership is releasing our fourth video. Pharmacist Ericka Shepard of CVS/pharmacy provides valuable tips on safely managing your medications. Experts suggest that as many as half of all prescription drugs are taken incorrectly. This video will help you whether you have year-round ailments, seasonal conditions, or the occasional illness.

Patients and their families often struggle with deciding the best course of care during the final months of life. Yesterday, WBUR of Boston began a weeklong series on "End of Life" care. Listen to yesterday's WBUR story with Jim Conway, Board Chair of the Partnership, who discusses the impact of a culture that often considers more care is better care. End of life care is also the topic of "Radio Boston" this week. Jim will participate in this call-in show on Friday May 1st at 1pm on WBUR.

A poll from the Kaiser Family Foundation, National Public Radio and the Harvard School of Public Health, suggests that people tend to trust that their own doctors provide appropriate care, but are skeptical of the treatment other patients receive from their physicians. Half of those surveyed believe the American health system has a "major problem" with patients receiving unnecessary tests. However, far fewer believe that they have personally received an unnecessary test or treatment (16%). In other words, the problem is the "other guy's doctor" and not "my doctor." In this environment how do we as individual patients and physicians begin to think about the problem of "overuse" in US health care?

The impact of Personal Health Records (PHRs) was discussed in a Boston Globe editorial. The editorial touches on "e-patient" Dave of Beth Israel Deaconess who found that his on-line PHR had inaccurate information about his condition. Patient Dave's experience reminds us to check for accuracy of our online records.

Other interesting news/articles this week include:
 

• Big Challenges Await Health-Records Transition, Wall Street Journal
• Effective medical treatment: $1.1 billion to study 'comparative effectiveness' research and evaluate therapies, Chicago Tribune

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April 21, 2009 — Effective Health Care “Tips”

This week, the Partnership is releasing our third video. Dr. D'Ottavio of Great Brook Valley Health Center in Worcester gives Spanish speaking patients simple tips to make the most of doctors' visits. We appreciate Dr. D'Ottavio helping us reach out to the Spanish speaking community.

Last week, The Joint Commission Journal on Quality and Patient Safety ran an article focusing on how health care organizations provide information to consumers. The article found that often these organizations provide "tips" that are not based on sound science. The authors stress the importance of making recommendations simple for consumers and based on medical evidence. This research supports the Partnership's campaign to give consumers easy to follow information based on the best evidence.

A New York Times article revealed that an alarming one-fifth of all Medicare patients discharged from the hospital end up back in the hospital within 30 days, and fully a third return within 90 days. These high rates of re-hospitalization are due to many factors – including breakdown of communications among providers and lack of patient/family understanding of follow up care needs. Proposed solutions include better discharge planning, more effective patient education and closer cooperation between hospitals and physicians to ensure proper follow-up care.

And finally, the Boston Globe reported on the halting of a pediatric surgery program after serious adverse events. The program in question had a relatively low volume of cases. For many types of surgeries, higher volume programs have been shown to have better outcomes. As patients and parents contemplate elective surgery, it is wise to consider how often a hospital or surgeon performs a particular procedure. For information about comparing hospitals, please click here.
 

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April 15, 2009 — Advance planning… make your wishes known: National Healthcare Decision Day

Today we are releasing our second video, in which Dr. Bob Klugman from UMass Memorial Medical Center gives viewers simple tips for making the most of your time with your doctor. We appreciate Dr. Klugman sharing his thoughts and practical advise. Please watch it and forward to your friends and family members.

The Boston Globe ran multiple articles this week about high rates of MRSA infections at a Boston hospital. While public health experts are still trying to determine if these 'super bug' infections were developed inside or outside of the hospital, it reminds all of us to take precautions, including regular handwashing, to reduce your risk of infections.

Last week, the MA Department of Public Health released its first report on Serious Reportable Events, or so-called "Never Events," that occured in MA hospitals over the past year. While the overall number may seem high (338 incidents last year), it is hard to put this number into context since this is just the first year of the report. For example, some hopsitals may have erred on the side of over-caution in making reports. It will be important to monitor trends as the Department issues reports in the future. Even in this first year of data, it is interesting to note that almost two-thirds of the events were patient falls. Attention to falls has encouraged many hosptials to institute preventative measures to reduce the number of falls.

And finally, this Thursday is National Healthcare Decision Day. The goal of the day is to encourage all adults to prepare advance directives, if they haven't already. Surveys show that fewer than 25% of adults in the U.S. have them. Each of us has the ability to guide our health care providers and our loved ones about what we want for our end-of-life care. I encourage you to use this opportunity to discuss your wishes with your family and complete an advance directive.

Other interesting news/articles this week include:
 

• The Sixth Annual HealthGrades Patient Safety in American Hospitals Study
• Why 'Quality' Care Is Dangerous, Wall Street Journal
• How Quality-of-Care Rules Can Lead Doctors Astray, Wall Street Journal

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