Friday, December 23, 2016

Good patient safety news you didn’t hear about

In the last five years, there’s been a 21% reduction in hospital acquired conditions (HACs) says a report by the Agency for Healthcare Research and Quality. This means that patients suffered 3.1 million fewer HACs than if the HAC rate had stayed at the 2010 level.

Since 2011, the decrease in HACs has reduced healthcare costs by an estimated $28.2 billion and has saved almost 125,000 lives.

This graphic summarizes the AHRQ findings.
Central line-associated bloodstream infections have fallen by 91%, and postoperative venous thromboembolism by 76%. Here’s a chart that shows the percent decreases in HACs.

The report said the reasons for these improvements “are not fully understood,” but might be due to the following:
  • Financial incentives created by the Centers for Medicare & Medicaid Services (CMS) and other payers’ payment policies,
  • Public reporting of hospital-level results,
  • Technical assistance offered to hospitals by the Quality Improvement Organization (QIO) program, and
  • Technical assistance and catalytic efforts of the HHS PfP [[Pay for Performance] initiative led by CMS.
An thorough Google search found a few articles about this important and positive AHRQ report. Were they in the New York Times, Washington Post, Newsweek, US News, or The Daily Mail?

No. the news could only be found on HealthcareIT Analytics, Fierce Healthcare, the website of the Healthcare Association of New York State, Pharmacy Practice News, and HealthcareIT News where I obtained the multicolored graphic above.

Why do you suppose no major media outlet reported the story?

Good news doesn’t get clicks.


artiger said...

If it bleeds, it leads...otherwise, forget about it. It's not sexy to be complimentary toward health care in the US.

Anonymous said...

There are quite a few other things that are not printed about healthcare that are bad. Many stories are simply 1 story that is splashed all over the other news' rehashed areas.

In addition, its not just health care like this. I have a few good politicians that way too.

Skeptical Scalpel said...

Artiger, I obviously agree.

Anon, I'd say most bad things in medicine make headlines.

William Reichert said...

YES BUT if all these lives have been saved this , then why in 2010 were there 2,468,435 deaths in the USA with a death rate of 747/100,000 but in 2016 there were 2,626,418 deaths with a death rate of 823/100,000.? Are all these people who were saved going home and reading their hospital bill and going to the top
of a tall building and jumping off?

Anonymous said...

I think it should be reported.

I think there are other possibilities for why it's not reported by major media outlets is that (1) there's other news trending - e.g. Trump transition (seems like there's new developments and names every day (2) the lay public generally has little understanding of the intricacies of the Health & Human Services regulatory network (myself included - it's taken months of Googling and I'm nowhere close to up to catching up with the entangled web of agencies that each regulate a piece of the health industry) and (3) it's not making it into the Associated Press Newswire - where a lot of journalists will check to pick up stories to follow up for publication. I'm not sure if the AHRQ does push-notifications/push-press releases.

Another challenge is that I'm not sure the public would understand the central line infection (I happened to Google, Wiki, and Youtube it to try to understand it better). At least at some government meetings I've attended, where Medicaid funds were specifically set aside to reward those hospitals who brought their CLABSI rates down, even the agencies did little to no press releases over their state-wide success beyond reporting it in the minutes of one of 30+ commissions. Multiply that by 1-2 meetings per month and you'd have to sort through 30 x 2 x 12 months to find it. Perhaps a press release would invite too much scrutiny over how the state's authority decided to divvy up those Medicaid funds and use it to reward CLABSI rate declines instead of some other condition associated with some other procedure(s). Or that it didn't want to bring attention to the monetary incentive to reduce infections.

William Reichert said...

Another reason it hasn't been reported is the distinct possibility
that the story is not true. This "lives saved" business has been
promoted before in the early 2000's. A careful review of that
claim of thousands of lives saved was published by two physicians.
Read about it here:
The conclusions of their review of the methods of the study is in the upper right hand corner of the first page.

Anonymous said...

I am a former newspaper reporter, now MS4 applying in a surgical field. I can tell you that even a decade ago when I was at a newspaper, there was a daily chart of the most "clicked" stories. This mentality has absolutely driven newspaper coverage, even more so than in prior eras. It means more and more our news is driven by what people want to hear - the preconceived notions they want reinforced - rather than reality. So we get to hear all about how fragile today's college students are (when I suspect there's not much new under the sun there), we get to hear about how incompetent our surgeons are (when surgery is as safe now as it has ever been), etc, etc, etc,

artiger said...

Like I said earlier, reinforced by Anon at 1:48pm, "if it bleeds, it leads". And as I've said on this site earlier, for those of us that see patients in the hospital, just look at what's on the TV in their hospital rooms when you are trying to visit them. It's usually a reality show, a melodramatic talk show, or a game show. This time of year, you might luck up and walk in to see a college FB Bowl game, but that won't last long.

A large portion of US citizens are consumers of trash, in more ways than one. The only news they are interested in is either fake news or sensationalism. Our future is trending toward the movie "Idiocracy".

Skeptical Scalpel said...

I believe AHRQ did post a press release

If it is wrong, I doubt that any media outlet would be able to figure that out. IMO, it's a conscious decision to ignore positive news about medicine.

It's about clicks, and bad news gets more of them.

Anonymous said...

The comments might explain why there are problems with newspapers. We could get docs and patients working together on problems but that would hurt the admin side of the house.

Anonymous said...

Fair points about leads that bleed and the gusto for doctor bashing, but I think I'll side with the big papers here. Their readership wouldn't be interested in a (to them) obscure topic that may or may not impact their lives at some undefined future time. Most people underestimate their chances of suffering catastrophic events, so this news would be perceived as even less important than it actually is.

On the other hand, this advance is definitely relevant for healthcare professionals. So it makes sense to me that it was mostly reported in specialized publications.

Finally, I'm curious about the 91% drop in catheter line infections. How did they pull that off?

Anonymous said...

Em... make it *central line infections* in the last pargraph.

Skeptical Scalpel said...

The AHRQ report said, "Although the precise causes of the decline in patient harm are not fully understood, the increase in safety has occurred during a period of concerted attention by hospitals throughout the country to reduce adverse events."

Regarding central line infections, many feel that the improvement stems from the checklist-driven protocol started about 10 years ago by Johns Hopkins critical care physician Peter Pronovost. It could also be a sustained Hawthorne effect of more intense scrutiny by regulators and consequently hospitals.

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