Tuesday, August 23, 2005
According to data recently gathered by the federal government, doctors and hospitals fail with alarming frequency to deliver essential lifesaving treatments for some of the most common causes of death, including heart attack, pneumonia, and heart failure, according to an article in the N.Y. Times. Even though the treatments are not controversial or complicated, they have been very difficult to deliver reliably in the complex setting of the hospital. The article points out that there is a 30 percent increase in the survival rate for patients who take aspirin in the first 24 hours after a hear attack, and yet hospitals neglected to give aspirin to more than 12,000 people, 1 of every 16 heart attack victims, in the first half of 2004. One in eight patients who should have received beta blockers did not.
Some hospitals claim this is a failure of documenting the treatment, and not that patients did not receive treatment. However, the American Hospital Association says that "[i]f the medications and tests are delivered and there's no documentation, that itself is a quality problem." This new report comes from the program Hospital Compare, in which 3,500 hospitals participate in exchange for a bonus in Medicare payments. In the state-by-state comparisons contained in the report card issued by Hospital Compare, Massachusetts led the states in basic heart attack care, delivering the appropriate therapy 97 percent of the time. Arkansas was last with 85 percent compliance. The hospital-level comparisons showed even greater variance in compliance with some at 100 percent and others at 50 percent.
Jean Rico, St. Vincent Medical Center's VP for quality services, says, "Physicians are much more willing to change their practice patterns now. . . . They know that more and more outcomes of care are being publicly reported." St. Vincent delivered the appropriate care 64 percent of the time. Dr. Ashish Jha of the Harvard School of Public Health says that "there hasn't been a clear incentive for them to put processes into place to make sure these treatments are given consistently. . . . [W]e haven't known what's been going on in hospitals, until now." See the twin studies on hospitals' performance in the New England Journal of Medicine.
My research assistant Lindley Bain provided invaluable assistance with this post. [tm]